Is Chiropractic a good way to treat cervical disc herniation?

The study says yes!         

This great study was led by Cynthia Peterson (who I’ve met and is no slouch – she’s a professor at the University of Zürich).  She and her team looked at the outcomes of patients with cervical (neck) radiculopathy caused by cervical disc herniation (CDH).  Radiculopathy is the term used to describe neck pain with arm pain that runs down a dermatome along with sensory, motor or reflex changes matching the involved nerve root.  Cynthia and her team carried out magnetic resonance imaging (MRI) to confirm that it was a cervical disc herniation that caused the signs and symptoms.

What is CerviCervical disc herniationcal Disc Herniation?

A disc herniation is where the content of the disc is forced against the elastic walls causing it to bulge.  This content is often described as having the consistency of toothpaste but is probably not quite as minty-white.  This bulge can then compress the nerve root, which is the first part of the nerve as it leaves the main spinal cord.  This compression causes the nerve to fail and leads to the signs and symptoms we’ve talked about.  The majority of these injuries occur at the C6 and C7 levels.

How common are Cervical Disc Herniation on MRI?

CDH are a really common finding even on scans of people with no problems whatsoever.  In a study it was found that 63% of over 40 athletic males had protruding discs but with no signs and symptoms.  The painful ones occur in 83.2 out of every 100,000 people and are generally caused by disc herniation, degenerative stenosis (which is a narrowing of the the gap that allows the nerve to leave and enter the protected spinal cord) or a combination of the two.  In the neck, CDH are the second most common cause of nerve root compression with degenerative stenosis being the most common.

And what are the sign and symptoms of cervical disc herniation?

CDH symptoms arise from compression of the nerve root.  These can include acute neck pain with associated arm pain following the distribution of the involved nerve root.  The arm pain may also be the predominant symptom with paraesthesia along the dermatomal pattern, a decreased reflex and weakness of the muscles innervated by the nerve root.

 And how’s it treated?

Conservative treatments are the wisest first option.  This can include lifestyle changes, pain medications, physiotherapy and spinal manipulative therapy (SMT).  If conservative therapies fail then treatment is often surgical.

And what happened in the study that was so impressive?

Most patients in this excellent study who were treated with high-velocity, low-amplitude spinal manipulation reported clinically significant improvement at all time points, particularly at 3 months.cervical-spine-side-view

The clinical outcomes of patients with cervical radiculopathy, confirmed by MRI, were treated with high-velocity, low-amplitude SMT in a chiropractic outpatient clinic.  The study looked at 50 patients.  At 2 weeks, 55.3% had “improved,” 68.9% at 1 month and 85.7% at 3 months.  Statistically significant decreases in neck pain, arm pain scores were noted at 1 and 3 months compared with baseline scores.  Impressively, of the subacute/chronic patients, 76.2% were improved at 3 months.

Using the classic steroid treatment, they reported that 24% of these patients with cervical disc herniation had clinically relevant reduction in their symptoms.  This is a 25% reduction in their score at 6 weeks and 4 months after injection.  The results of this current study using SMT for the subacute/chronic patients had substantially better results with more than 76% reporting clinically relevant improvement and a 65% reduction in arm pain as well as a 59% reduction in neck pain NRS scores at 3 months.

However, the patients in this study included those with symptoms between 4 and 12 weeks as well as those whose symptoms were longer than 3 months.  This may have favourably influenced the results.  The mean duration of the symptoms in this subacute/chronic cohort was over 298 days!Cervical disc damage

It is important to point out that even the subacute/chronic patients in this study with symptoms lasting longer than 4 weeks (mean duration, 298.73 days) reported high levels of clinically significant improvement.  This is clinically important as the chronic patients are the ones who are usually the costliest in terms of health care use and quality-of-life disruption.

Summary

A high proportion of acute and, most importantly, subacute/chronic patients with MRI-confirmed symptomatic cervical disc herniation treated with high-velocity, low-amplitude cervical spine manipulation reported clinically relevant improvement at 1 and 3 months after the first treatment.

There were no adverse events reported for patients in this study.

SOURCE:   J Manipulative Physiol Ther 2013 (Oct); 36 (8): 461–467

Cynthia K. Peterson, RN, DC, M.Med.Ed, Christof Schmid, DC, Serafin Leemann, DC, Bernard Anklin, DC, B. Kim Humphreys, DC, PhD

Professor, Department of Chiropractic Medicine, Faculty of Medicine, Orthopedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland. Electronic address: xraydcpeterson@yahoo.ca

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