Editor's note: Space constraints prohibit us from reproducing all abstracts from the January 2007 issue of JMPT. To review the complete table of contents for the January issue, please visit www.mosby.com/jmpt.
Prevalence of Modic degenerative marrow changes in the cervical spine.
Cynthia K.
Objective: The prevalence and distribution of Modic degenerative marrow changes as seen on magnetic resonance imaging scans have been reported for the lumbar spine, and research suggests that type 1 Modic changes are linked to low back pain. The purpose of this study was to report on the prevalence, types, and distribution of the changes found for the cervical spine.
Methods: One hundred thirty-three cervical spine T1-weighted and T2-weighted sagittal magnetic resonance imaging scans were viewed retrospectively by two radiologists. Data were recorded for patient age, patient sex, and the presence or absence of Modic changes. If Modic changes were present, then the precise vertebral levels of these changes and the specific Modic type were recorded. Descriptive statistics were calculated for the prevalence of Modic changes overall, the prevalence of types 1, 2, and 3 changes, and the prevalence in male vs. female patients. The frequency of these changes by spinal level was also determined.
Results: One hundred eighteen patients met the inclusion criteria. Modic changes were seen in 19 patients (16%), with four showing changes in more than one segmental level. The most common Modic change observed was type 1. Type 3 marrow changes were the second most common category to be noted. Only three patients had Modic type 2 marrow changes. The most common cervical spinal level to show Modic changes was C5-6.
Conclusions: Modic degenerative bone marrow changes are observed in the cervical spine, with the C5-6 level being the most commonly involved. Unlike in the lumbar spine in which Modic type 2 changes predominate, type 1 marrow changes were far more common in the cervical spine. Further studies should focus on the clinical relevance of these findings.
Manual forces applied during cervical mobilization.
Suzanne J. Snodgrass, MMedSc, Darren A. Rivett, PhD, Val J. Robertson, PhD
Objective: Manual therapists routinely use passive accessory mobilization techniques to treat patients with mechanical neck disorders, but little is known about the manual forces applied. The aim of this study was to quantify the manual forces applied to the cervical spine during joint mobilization.
Methods: Ten physiotherapists performed posterior-to-anterior mobilizations to C2 and C7 (both centrally and unilaterally, 1 right and 1 left, grades I-IV) on a single asymptomatic male subject. Manual forces were measured in three planes using an instrumented treatment table.
Results: The instrumented table showed excellent reliability (intraclass correlation coefficient [2,1], 0.99; 95% confidence interval, 0.97-1.00) and accuracy (mean absolute error; vertical force, 1.1 N; SD, 1.5). There were considerable differences between therapists for mean peak force, force amplitude, and oscillation frequency for each technique and grade. Mean peak forces (grade I, 21.8 N; SD, 15.0; grade II, 34.9 N; SD, 20.9; grade III, 58.2 N; SD, 27.5; grade IV, 61.0 N; SD, 29.9) were considerably lower than previously reported lumbar mobilization forces. Intratherapist repeatability for all mobilization parameters was high. Force amplitude and oscillation frequency measures indicated that therapists generally adhered to the published definitions of the grades of mobilization when applying force, but when asked, provided quite different definitions of the grades.
Conclusions: This study provides preliminary evidence that cervical mobilization forces vary considerably between therapists, but intratherapist repeatability is high.
Reproduction of the lumbar lordosis: a comparison of standing radiographs versus supine magnetic resonance imaging obtained with straightened lower extremities.
Marianne Logtholt Andreasen, MSc, Lotte Langhoff, MSc, Tue Secher Jensen, MSc, Hanne B. Albert, PT, MPH, PhD
Objective: This study investigates whether it is possible to reproduce the lumbar lordosis in the upright position during magnetic resonance imaging (MRI) by positioning the patient supine with straightened lower extremities and investigates intra- and interexaminer reliability of measurements of the lumbar lordosis on radiographs and MRI.
Methods: This was an observational study, which included an intra- and interexaminer reliability study. Lumbar lordosis was measured digitally on radiographs taken from 22 patients in an upright standing position, and 22 MRI scans of the same patients lying supine with straightened lower extremities. These measurements were compared statistically. Intra- and interexaminer reliability was calculated applying the Bland and Altman method.
Results: The lumbar lordosis in the standing position was reproduced in the straightened supine position with a median deviation of 3 degrees. Intra- and interexaminer reliability was better for MRI than for radiographs. The mean differences were close to 0, especially for interexaminer reliability during MRI. On radiographs, there was a higher agreement on interexaminer than on intra-examiner reliability.
Conclusion: The findings of this study show that lumbar lordosis in the upright position can be reproduced by positioning the patient supine with straightened lower extremities.
Patient perceptions of chiropractic treatment for primary care disorders.
Jerrilyn A. Cambron, DC, PhD, Gregory D. Cramer, DC, PhD, James Winterstein, DC
Objective: Although some surveyed groups of chiropractors consider themselves qualified as primary care providers, consumer attitudes of such may affect practice success. The purpose of this study is to determine chiropractic patients' perception of chiropractors as primary care providers and to determine what disorders patients believe chiropractors can treat.
Methods: A 2-page survey was developed to collect information from current chiropractic patients at a teaching chiropractic clinic in the United States. Questions included (1) brief patient demographic information; (2) whether their chiropractor was their primary care physician; and (3) patient beliefs about chiropractors assessing and treating conditions that are common to a primary care medical practice. Conditions listed in the survey were based on a previous study on primary care medical physicians' practices. The sample of chiropractic patients was divided into suburban, urban, and chiropractic university-affiliated patients.
Results: There were 163 subjects who responded to this survey for a 58% response rate. Only 19% (30/157) saw their chiropractor as their primary care physician. However, for each "primary care condition" listed, the percent of patients who affirmed that chiropractors could treat the condition varied greatly, with many conditions showing an affirmative response of higher than 50%, especially in the urban and university-affiliated patient groups. All patients overwhelmingly believed that chiropractors could treat musculoskeletal conditions.
Conclusions: Patients have varied views of what chiropractors can and cannot treat. Further studies are needed to determine the effectiveness of chiropractic treatment for specific primary care disorders. The results of such studies may be the determining influence for public and physician opinion on the appropriateness of chiropractic care for these conditions.
Development of a computerized intervertebral motion analysis of the cervical spine for clinical application.
Mathieu Piché, DC, MSc, Pierre Benoît, DC, Julie Lambertc, Virginie Barretted, Emmanuelle Grondine, Julie Martelf, Amélie Parég, André Cardin, DC
Objective: The objective of this study was to develop a measurement method that could be implemented in chiropractic for the evaluation of angular and translational intervertebral motion of the cervical spine.
Methods: Flexion-extension radiographs were digitized with a scanner at a ratio of 1:1 and imported into a software, allowing segmental motion measurements. The measurements were obtained by selecting the most anteroinferior point and the most posteroinferior point of a vertebral body (anterior and posterior arch, respectively, for C1), with the origin of the reference frame set at the most posteroinferior point of the vertebral body below. The same procedure was performed for both the flexion and extension radiographs, and the coordinates of the two points were used to calculate the angular movement and the translation between the two vertebrae.
Results: This method provides a measure of intervertebral angular and translational movement. It uses a different reference frame for each joint instead of the same reference frame for all joints and thus provides a measure of motion in the plane of each articulation. The calculated values obtained are comparable to other studies on intervertebral motion and support further development to validate the method.
Conclusion: The present study proposes a computerized procedure to evaluate intervertebral motion of the cervical spine. This procedure needs to be validated with a reliability study but could provide a valuable tool for doctors of chiropractic and further spinal research.
A pilot study comparing two manual therapy interventions for carpal tunnel syndrome.
Jeanmarie Burke, PhD, Dale J. Buchberger, DC, PT, M. Terry Carey-Loghmani, MS, PT, Paul E. Dougherty, DC, Douglas S. Greco, DC, MS, J. Donald Dishman, DC, MS
Objective: The purpose of this study was to determine the clinical efficacy of manual therapy interventions for relieving the signs and symptoms of carpal tunnel syndrome (CTS) by comparing 2 forms of manual therapy techniques: Graston Instrument-assisted soft-tissue mobilization (GISTM) and STM administered with the clinician's hands.
Methods: The study was a prospective comparative research design in the setting of a research laboratory. Volunteers were recruited with symptoms suggestive of CTS based upon a phone interview and confirmed by electrodiagnostic study findings, symptom characteristics, and physical examination findings during an initial screening visit. Eligible patients with CTS were randomly allocated to receive either GISTM or STM.
Interventions were, on average, twice a week for four weeks and once a week for two additional weeks. Outcome measures included (1) sensory and motor nerve conduction evaluations of the median nerve; (2) subjective pain evaluations of the hand using visual analog scales and Katz hand diagrams; (3) self-reported ratings of symptom severity and functional status; and (4) clinical assessments of sensory and motor functions of the hand via physical examination procedures. Parametric and nonparametric statistics compared treated CTS hand and control hand and between the treatment interventions, across time (baseline, immediate post, and at three months' follow-up).
Results: After both manual therapy interventions, there were improvements to nerve conduction latencies, wrist strength, and wrist motion. The improvements detected by our subjective evaluations of the signs and symptoms of CTS and patient satisfaction with the treatment outcomes provided additional evidence for the clinical efficacy of these two manual therapies for CTS. The improvements were maintained at three months for both treatment interventions. Data from the control hand did not change across measurement time points.
Conclusions: Although the clinical improvements were not different between the two manual therapy techniques, which were compared prospectively, the data substantiated the clinical efficacy of conservative treatment options for mild to moderate CTS.
A congenital anomaly of the atlas as a diagnostic dilemma: a case report.
Annemarie de Zoete, DC, Ursula A. Langeveld, DC, MS
Objective: The purpose of this case report is to draw attention to the differences between a Jefferson fracture and a congenital anomaly of the anterior and/or the posterior arch of the atlas.
Clinical Features: A 42-year-old woman visited the chiropractic practice complaining of headache, neck pain, dizziness, and numbness in both of her arms after she fell vertically and directly on her head twice on a playground. Before this fall, she had no such complaints. After taking X-rays of the cervical spine, a Jefferson fracture was suspected.
Intervention and Outcome: After computed tomography and magnetic resonance imaging scanning, the patient was diagnosed with a congenital anomaly that looked very similar to a Jefferson fracture. After instability of the cervical spine was excluded by the neurosurgeon, chiropractic treatment was delivered. After 5 ½ treatments, the complaints were significantly reduced.
Conclusion: It is important to be familiar with the differences between a congenital anomaly of the atlas and a Jefferson fracture and to exclude instability of the upper cervical spine before treatment is started.
Resolution of symptoms of chronic constipation in an 8-year-old male after chiropractic treatment.
David M. Quist, DC, Stephen M. Duray, PhD
Objective: This case report describes the history, treatment, and proposed explanation of a positive outcome in a patient with chronic constipation.
Clinical Features: An 8-year-old boy presented with chronic constipation. His mother reported that this had been a problem since the child's birth. Allopathic treatment consisting of laxatives, high fluid intake, and high fiber intake had not been effective to date.
Intervention and Outcome: The patient was examined and it was determined that he had a sacral chiropractic subluxation complex. Manipulation of the sacral area using diversified adjusting procedures was performed. External massage of the abdomen starting in the right lower quadrant and following the course of the large intestine in a clockwise direction was also applied. The patient reported an immediate dramatic improvement in bowel function after the first treatment. Treatment was continued for a four-week period (two visits per week) and then discontinued when the patient (confirmed by his mother) reported consistent normal bowel function. A follow-up call made 13 years after treatment revealed continuing normal bowel function.
Conclusion: This case suggests that chiropractic care may be helpful in some cases of chronic constipation.
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