title: Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy.
abstract: The purpose of this study was to compare the outcomes of overall improvement, pain reduction, and treatment costs in matched patients with symptomatic, magnetic resonance imaging-confirmed cervical disk herniations treated with either spinal manipulative therapy (SMT) or imaging-guided cervical nerve root injection blocks (CNRI).
  
  
  
  This prospective cohort comparative-effectiveness study included 104 patients with magnetic resonance imaging-confirmed symptomatic cervical disk herniation. Fifty-two patients treated with CNRI were age and sex matched with 52 patients treated with SMT. Baseline numerical rating scale (NRS) pain data were collected. Three months after treatment, NRS pain levels were recorded and overall "improvement" was assessed using the Patient Global Impression of Change scale. Only responses "much better" or "better" were considered "improved." The proportion of patients "improved" was calculated for each treatment method and compared using the χ(2) test. The NRS and NRS change scores for the 2 groups were compared at baseline and 3 months using the unpaired t test. Acute and subacute/chronic patients in the 2 groups were compared for "improvement" using the χ(2) test.
  
  
  
  "Improvement" was reported in 86.5% of SMT patients and 49.0% of CNRI patients (P = .0001). Significantly more CNRI patients were in the subacute/chronic category (77%) compared with SMT patients (46%). A significant difference between the proportion of subacute/chronic CNRI patients (37.5%) and SMT patients (78.3%) reporting "improvement" was noted (P = .002).
  
  
  
  Subacute/chronic patients treated with SMT were significantly more likely to report relevant "improvement" compared with CNRI patients. There was no difference in outcomes when comparing acute patients only.
authors.affiliation: Professor, Radiology Department, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland; Professor, Chiropractic Medicine Department, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland. Electronic address: xraydcpeterson@yahoo.ca.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Peterson
authors.affiliation: Professor, Head of Radiology Department, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland.
authors.forename: Christian W A
authors.initials: CW
authors.lastname: Pfirrmann
authors.affiliation: Professor, Head of Radiology Department, University Hospital, University of Zürich.
authors.forename: Jürg
authors.initials: J
authors.lastname: Hodler
authors.affiliation: Private Practice, Zürich, Switzerland.
authors.forename: Serafin
authors.initials: S
authors.lastname: Leemann
authors.affiliation: Private Practice, Zürich, Switzerland.
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Private Practice, Zürich, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Anklin
authors.affiliation: Professor, Department Head, Chiropractic Medicine, Faculty of Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland.
authors.forename: B Kim
authors.initials: BK
authors.lastname: Humphreys
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000628:therapy*; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012720:Severity of Illness Index; D013126:Spinal Nerve Roots
keywords: Cervical Spine; Comparative-Effectiveness Research; Disk Herniation; Injections; Manipulation, Spinal; Nerve Root; Outcomes Assessment; Radiculopathy