Outcomes from magnetic resonance imaging-confirmed symptomatic cervical disk herniation patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up.
OBJECTIVE
The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.


METHODS
Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included. Magnetic resonance imaging-confirmed CDH linked with symptoms was required. Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient's global impression of change data were collected. High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic. The proportion of patients responding "better" or "much better" on the patient's global impression of change scale was calculated. Pretreatment and posttreatment NRSs and NDIs were compared using the Wilcoxon test. Acute vs subacute/chronic patients' NRSs and NDIs were compared using the Mann-Whitney U test.


RESULTS
Fifty patients were included. At 2 weeks, 55.3% were "improved," 68.9% at 1 month and 85.7% at 3 months. Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores (P < .0001). Of the subacute/chronic patients, 76.2% were improved at 3 months.


CONCLUSIONS
Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging-confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.
Professor, Department of Chiropractic Medicine, Faculty of Medicine, Orthopedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland. Electronic address: xraydcpeterson@yahoo.ca.
Cynthia K
CK
Peterson
Christof
C
Schmid
Serafin
S
Leemann
Bernard
B
Anklin
B Kim
BK
Humphreys
D000328:Adult; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000628:therapy*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D059408:Pain Management / Q000379:methods; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
Chiropractic; Intervertebral Disk Displacement; Manipulation; Neck Pain; Spine