title: Symptomatic, MRI Confirmed, Lumbar Disc Herniations: A Comparison of Outcomes Depending on the Type and Anatomical Axial Location of the Hernia in Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation.
abstract: The purpose of this study was to evaluate whether specific MRI features, such as axial location and type of herniation, are associated with outcomes of symptomatic lumbar disc herniation patients treated with spinal manipulation therapy (SMT).
  
  
  
  MRI and treatment outcome data from 68 patients were included in this prospective outcomes study. Pain numerical rating scale (NRS) and Oswestry physical disability questionnaire (OPDQ) levels were measured at baseline. The Patients Global Impression of Change scale, the NRS and the OPDQ were collected at 2 weeks, 1, 3, 6 months and 1 year. One radiologist and 2 chiropractic medicine master's degree students analyzed the MRI scans blinded to treatment outcomes. κ statistics assessed inter-rater reliability of MRI diagnosis. The proportion of patients reporting relevant improvement at each time point was compared based on MRI findings using the chi-square test. The t test and ANOVA compared the NRS and OPDQ change scores between patients with various MRI abnormalities.
  
  
  
  A higher proportion of patients with disc sequestration reported relevant improvement at each time point but this did not quite reach statistical significance. Patients with disc sequestration had significantly higher reduction in leg pain at 1 month compared to those with extrusion (P = .02). Reliability of MRI diagnosis ranged from substantial to perfect (K = .733-1.0).
  
  
  
  Patients with sequestered herniations treated with SMT to the level of herniation reported significantly higher levels of leg pain reduction at 1 month and a higher proportion reported improvement at all data collection time points but this did not reach statistical significance.
authors.affiliation: Chiropractic Medicine Student, Chiropractic Medicine Department, Faculty of Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Ehrler
authors.affiliation: Professor, Chiropractic Medicine Department, Faculty of Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland. Electronic address: xraydcpeterson@yahoo.ca.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Peterson
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 and Department Head, Chiropractic Medicine Department, Faculty of Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland.
authors.forename: B Kim
authors.initials: BK
authors.lastname: Humphreys
mesh_terms: D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000628:therapy*; D007866:Leg; D017116:Low Back Pain / Q000473:pathology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D059408:Pain Management; D056888:Patient Positioning; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Intervertebral Disc Displacement; Lumbar Vertebrae; Magnetic Resonance Imaging; Manipulation; Spinal; Spine