title: Characteristics of lumbar disc herniation with exacerbation of presentation due to spinal manipulative therapy.
abstract: The aim of this article was to delineate the characteristics of lumbar disc herniation (LDH) in patients with exacerbation of symptoms caused by spinal manipulative therapy (SMT). The main emphasis should be on the prevention of this condition by identifying relevant risk factors. Detailed clinico-radiological profiles of a total number of 10 LDH patients with exacerbation of presentation after SMT were reviewed. All the patients underwent neurological and magnetic resonance imaging examinations. Laminectomy and discectomy were performed, and follow-up was carried out in all patients. The duration of symptoms in the patients before SMT was 4-15 years. After the therapy, an acute exacerbation of back and radicular pain was observed within 24 h. Magnetic resonance imaging showed that L4-L5 was the most frequently affected level observed (7 patients), and each patient had a large disc fragment in the spinal canal. The disc fragments were classified into 3 types according to their localizations. The time internal between the exacerbation of presentation and surgery was 23.1 days. No perioperative complications were noted. All the patients were relieved of radicular pain a few days after surgery. During postoperative follow-up, all patients regained the ability to walk; one patient received catheterization for 1 month and another for 6 months. Eight patients reported a complete resolution of presentation and the rest 2 patients were significantly improved. SMT should be prohibited in some LDH patients to prevent neurological damages, in whom there are 5 possible risk factors. Surgical results for these patients are encouraging.
authors: From the Department of Orthopaedics (S-LH, H-WY), Central Laboratory for Scientific Research (G-LY), Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an; Department of Neurosurgery (Y-XL), First Hospital of Yulin City, Yulin; and Department of Orthopaedics (JZ), Weinan Central Hospital, Weinan, China.
authors: Sheng-Li
authors: SL
authors: Huang
authors: Yan-Xi
authors: YX
authors: Liu
authors: Guo-Lian
authors: GL
authors: Yuan
authors: Ji
authors: J
authors: Zhang
authors: Hong-Wei
authors: HW
authors: Yan
mesh_terms: D000368:Aged; D017586:Diskectomy; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D007796:Laminectomy; D017116:Low Back Pain / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D020393:Manipulation, Spinal / Q000009:adverse effects*; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology