A New Chiropractic Twist is Spreading

A new chiropractic twist is spreading. It is called manipulation under anesthesia and it’s being used throughout hospitals and surgical centers throughout New Jersey.

Chronic pain sufferers across the nation have already discovered tremendous health benefits that can be restored by Manipulation Under Anesthesia, or M.U.A.

MUA as we call it is a well established, Mercy guideline accepted, procedure that osteopaths have performed for years and have since given up. Proponents of MUA say it’s indicated mostly for the 5% to 10% of those chiropractic patients whose spinal adjustments would be too painful without anesthesia.

The combination of manipulation and anesthesia is not new, as this treatment has been part of the manual medical arena for more than 60 years. Manipulation Under Anesthesia is an established medical procedure with a CPT Code designate of 22505. This is noted in the American Medical Association’s Current Procedural Terminology Publication.

Chiropractic patients and chronic pain sufferers throughout New Jersey are discovering that manipulation under anesthesia has tremendous health benefits.

The physical and emotional outcomes have been miraculous when using MUA and quality of lives have been restored. People who previously could not perform normal daily activities are now able to shop, wash their hair, go dancing, bend over to pick up a child, do simple household chores, or rid themselves completely of agonizing chronic back pain without having to go under the knife.

For those of you that are unfamiliar with the procedure, MUA is exactly what it sounds like. Occasionally, certain spinal conditions fail to respond sufficiently to conventional care of chiropractors, physical therapists or even medical doctors. Some of the impediments to in-office adjustment of the spine that may require the aid of an anesthetic are

1. Buildup of scar tissue (adhesions) both in and around the spinal joints commonly caused by multiple injuries or failed back surgery.

2. Chronic muscle spasm

3. Super-sensitivity of injured areas making the patient unable to cooperate for effective treatment

4. Herniated and or bulging discs.

5. Spinal surgery.

After medical clearance, the patient is lightly anesthetized to achieve total relaxation, then manipulations and stretching movements, which would normally be too painful to perform in the private office setting to even consider, are easily, painlessly and quickly performed.

Typically the chiropractor will recommend MUA when joints in the vertebral column become locked and immovable. It is the chiropractors' responsibility to restore the function to previously movable joints.

Anesthesia is especially needed when movement or manipulation of the spine becomes extremely and intolerably painful, the benefit of being unconscious becomes obvious, but the anesthesia performs other important functions, such as:

• Shuts down the muscle spasm cycle to allow spinal movement

• Sedates the pain perceiving nerves that have been irritated due to the dysfunctional spine.

• Allows complete muscle relaxation to allow the doctor to stretch fibrotically shortened muscle groups and breakdown these adhesions caused by scar tissue.

M.U.A. has also been shown to be effective in relieving pain in cases of persistent shortening of muscles, ligaments damaged intervertebral discs. Some disc injuries are serious enough to require surgery, but they are relatively infrequent.

Manipulation under anesthesia uses a combination of specific short lever manipulations, passive stretches and specific articular and postural kinesthetic maneuvers in order to break up fibrous adhesions and scar tissue around the spine and surrounding tissue.

The manipulation procedures can be offered in any of the following ways:

• Under general anesthesia
• During conscious sedation “twilight sleep”
• Following the injection of anesthetic solutions into specific tissues of the spine.

The doctor performing the MUA must be a licensed physician with specialized training from a CCE accredited college regardless of whether the doctor is an MD or DC.

The true benefit of MUA is that it requires a team approach in order to have a safe and successful outcome. The team must include the physician/surgeon/chiropractor who performs the manipulation, and the first assistant, also a physician/chiropractor certified in manipulation under anesthesia. The procedure is commonly performed in a hospital or surgical center.

Which patients should be considered for manipulation under anesthesia? Certain neck, mid back, low back or other spinal conditions respond poorly to conventional care. One proposed theory for this is that, as a result of past or present injury, adhesions and scar tissue have built up around spinal joints and within the surrounding muscles and causes chronic pain.

Patients often undergo various treatments, such as physical therapy, chiropractic care, epidural injections, back surgery, or other treatments that do not address fibrous adhesions. Some patients feel temporarily better with these treatments, but their pain often returns.
In general, patients selected for manipulation under anesthesia are those who have received conservative care for six to eight weeks. If limited or no improvements in symptoms or objective findings have occurred, then manipulation under anesthesia may be an appropriate alternative.

Prior to treatment, protocols of diagnostic testing should document the nature of the diagnosis, support the need for treatment and eliminate questions of psychosocial factors that can influence pain responses. In addition to X-ray, MRI scan or CT scan, a musculoskeletal sonogram or nerve conduction velocity test may be ordered.

Of course there are those patients who should not be considered for MUA. Being that the main reason for having an MUA is the persistence of a dysfunctional and disabling spine that has built up fibrotic adhesion, the absence of joint dysfunction is a good reason not to undergo MUA. The following conditions would be contraindications for MUA:

• Severe osteoporosis
• Heart disease and uncontrolled hypertension
• Advanced age
• Bone weakening diseases
• Cancer
• Some circulatory diseases
• Uncontrolled diabetes
• Previous stroke.

The following are several research studies about the effectiveness of manipulation under anesthesia, including:

1. 83% of 600 patients with EMG verified radiculopathies reported significant improvement - Robert Mensor, MD

2. Patients that had back pain for a minimum of 10 years reported an 87% recovery rate after MUA - 1987 with Ongly et al

3. 51% of patients with unrelieved symptoms after conservative care had been exhausted reported good to excellent results three years post MUA - Donald Chrisman, MD

4. 71% of 723 MUA patients had good results (return to normal activity relatively symptom free) and 25.3% had fair results (return to normal activity with slight residuals) and that flexibility, elasticity and range of motion can be restored following MUA - Bradford and Siehl

5. 83% of 517 patients treated with MUA responded well - Paul Kuo, MD professor of Orthopedic Surgery

6. Krumhansi and Nowacek reported on an MUA study done on 171 patients who experienced constant intractable pain for several months to 18 years.

All of the patients of the study failed other conservative intervention. The results of the study showed that 25% of the patients had no pain, 50% were much improved with pain markedly decreased, 20% were better and could tolerate their pain but it interfered with work and recreation. Failures comprised 5% where there was minimal or no pain relief periods.

Diagnosis of herniated disc reported excellent to good results in:

60% - PC Colonna and ZB Friendenberg: 1949
64% - Merrill C Mensor, MD: 1949
60% - Donald Sielh, DC: 1963

In reading the latest medial literature it clearly demonstrates that for over forty years chronic neuromuscular skeletal conditions that have failed the conservative protocol respond well to manipulation under anesthesia.

The overall effectiveness of spinal manipulation under anesthesia has been reported by researchers with success rates varying according to case selection criteria.

Without a doubt this procedure has been used effectively for years by chiropractors and other manual practitioners. Make no mistake that although this procedure may or may not change the face of chiropractic. It will change the lives of many people for the better. I urge the reader to consider incorporating this technique into your arsenal of treatment.

Dr. Jason Tirado
MUA Research Institute
http://www.muamastery.com/