Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study

Thunder-fire moxibustion for lumbar disc herniation: A systematic review and meta-analysis

BACKGROUND

Lumbar disc herniation (LDH) is a common degenerative disease that severely impacts the quality of life of patients. Thunder-fire moxibustion is an ancient Chinese medicine-based external therapeutic procedure that has been employed for pain relief until this day. The focus of our study was to demonstrate the effectiveness and safety of thunder-fire moxibustion in the treatment of LDH.

METHODS

The literature databases searched included the Cochrane Library, Web of Science, Springer, PubMed, Wanfang digital periodicals database, China national knowledge infrastructure, VIP, and Chinese biomedical literature database, and the search period was from database creation to March 2022. These include randomized controlled trials of Thunder-Fire moxibustion alone or in combination with other therapies for LDH. Two evaluators independently extracted data. We accessed the quality of inclusive studies through a Cochrane risk of bias tool. Meta-analyses were performed using Review Manager (Version 5.5). Data was analyzed using fixed-effects or random-effects models, depending on the heterogeneity test results.

RESULTS

The meta-analysis included 17 studies involving 1344 patients with LDH. The analysis results were as follows: compared with other therapies, the efficacy of thunder-fire moxibustion was statistically significant; the total effective rate (RR = 1.20; 95%CI [1.15, 1.26]; P < .00001), the Japanese orthopaedic association score (MD = 4.42; 95%CI [4.10, 4.73]; P < .00001), the pain score (SMD = -2.66; 95% CI [-3.39, -1.94]; P < .00001). Only 2 reported no adverse events in the included literature, and the remaining had no relevant records. The quality of the evidence in the 17 papers we examined was low or very low.

CONCLUSION

Thunder-Fire moxibustion is effective in relieving discomfort in patients with LDH. It has significant clinical efficacy, but there is still a need for prospective, multicentre, large-sample randomized controlled trials to enhance the clinical evidence due to the quality of included studies and methodological limitations.

Effect of traditional Chinese manual therapy on alleviating pain and dysfunction of lumbar disc herniation: a randomized controlled pilot study

OBJECTIVE

To investigate the effect of traditional Chinese manual therapy (TCMT) in alleviating pain and dysfunction in patients with lumbar disc herniation (LDH).

METHODS

Sixty-six patients with LDH were recruited as the study cohort and randomly assigned to an observation group and a control group. The patients in the observation group underwent TCMT, whereas those in the control group underwent conventional lumbar traction (LT). The observed indexes comprised primary index, which referred to clinical efficacy, and secondary indexes, which include Simplified McGill Pain Questionnaire, Oswestry Disability Index (ODI), range of motion (ROM) of the lumbar spine, difference in muscle tone (MT) and pressure pain threshold (PPT) of the bilateral erector spinae, and serum inflammatory factor levels.

RESULTS

The total effective rate was significantly higher in the observation group than in the control group (96.67% vs. 66.67%, P < 0.001). Compared with the control group after treatment, patients in the observation group had significantly lower ODI, pain rating index, visual analog scale and present pain intensity scores (all P < 0.05), and had significantly smaller differences in MT and PPT of the bilateral erector spinae (both P < 0.001), but had remarkably greater ROM of the lumbar spine (P < 0.001). In addition, interleukin (IL)-6, IL-8, and interferon-γ concentrations in the observation group were significantly lower than those in the control group after treatment (all P < 0.05).

CONCLUSION

TCMT has positive effects on alleviating pain and improving dysfunction of patients with LDH and helps in reducing serum inflammatory factor levels.

Biomechanical analysis of sacroiliac joint motion following oblique-pulling manipulation with or without pubic symphysis injury

Background: Oblique-pulling manipulation has been widely applied in treating sacroiliac joint (SIJ) dysfunction. However, little is known about the biomechanical mechanism of the manipulation. This study aims to analyze the SIJ motion under oblique-pulling manipulation, in comparison with compression and traction loads.

Methods/Study Design: A total of six specimens of embalmed human pelvis cadavers were dissected to expose the SIJ and surrounding ligaments. Through a servo-hydraulic testing system, biomechanical tests were performed on the stable pelvis and the unstable pelvis with pubic symphysis injury (PSI). A three-dimensional (3D) photogrammetry system was employed to determine the separation and nutation in three tests: axial compression (test A), axial traction (test B), and oblique-pulling manipulation (test C).

Results: After applying the testing loads, the range of nutation was no more than 0.3° (without PSI) and 0.5°(with PSI), separately. Except for test B, a greater nutation was found with PSI (p < 0.05). Under both conditions, nutation following test A was significantly greater than that of other tests (p < 0.05). SIJ narrowed in test A and separated in tests B and C, where the range of motion did not exceed 0.1 mm (without PSI) or 0.3 mm (with PSI) separately. Under both conditions, the separation of SIJ in test C was not as apparent as the narrowness of SIJ in test A (p < 0.05). Compared to SIJ, a more significant increasing displacement was found at the site of the iliolumbar ligament (p < 0.05). Nevertheless, when the force was withdrawn in all tests, the range of nutation and separation of SIJ nearly decreased to the origin.

Conclusion: Pubic symphysis is essential to restrict SIJ motion, and the oblique-pulling manipulation could cause a weak nutation and separation of SIJ. However, the resulting SIJ motion might be neutralized by regular standing and weight-bearing load. Also, the effect on SIJ seems to disappear at the end of manipulation. Therefore, the stretching and loosening of surrounding ligaments need to be paid more attention to.

Minimally Invasive and Conservative Interventions for the Treatment of Sacroiliac Joint Pain: A Review of Recent Literature

Sacroiliac joint (SIJ) pain is responsible for approximately 15-25% of reported back pain. Patients with SIJ pain report some of the lowest quality of life scores of any chronic disease. Understanding of the physiology and pathology of the SI joint has changed dramatically over the years, and SI joint pain and injury can now be thought of in two broad categories: traumatic and atraumatic. Both categories of SI joint injury are thought to be caused by inflammation or injury of the joint capsule, ligaments, or subchondral bone in the SI joint. Treatment of SI joint pain usually involves a multi-pronged approach, utilizing both, multi-modal medical pain control and interventional pain/surgical techniques such as steroid injections, radiofrequency nerve ablation, and minimally invasive sacroiliac arthrodesis. Though conservative management through multi-modal pain control and physical therapy have their role as first line therapies, an increasing body of evidence supports the use of minimally invasive procedures, both as adjuvant treatments to conservative management and as second line therapies for patient's that fail first line treatment.

Prognosis Evaluation of MRI Combined with Magnetic Resonance Myelography on Lumbar Disc Herniation after Transforaminal Endoscopic Discectomy

Objective

This study sets out to investigate the role of magnetic resonance imaging (MRI) combined with magnetic resonance myelography (MRM) in patients after percutaneous transforaminal endoscopic discectomy (PTED) and to evaluate its value in postoperative rehabilitation.

Methods

The clinical date of 96 patients with lumbar disc herniation (LDH) after PTED was retrospectively analyzed. The enrolled patients were divided into MRI group (n = 32) and MRI + MRM group (n = 64) according to whether MRM was performed. The nerve root sleeve (morphology, deformation) and dural indentation, intervertebral space height (ISH), intervertebral space angle (ISA), degree of pain (Visual Analogue Scale (VAS)), vertebral function (Japanese Orthopaedic Association (JOA)), and long-term recurrence were compared between the two groups.

Results

Compared with the MRI group, the MRI + MRM group better displayed nerve root morphology, sheath sleeve deformation, and dural indentation. Both MRI and MRI + MRM showed ISH and ISA changes well. Compared with the MRI group, the MRI + MRM group had a significantly lower VAS score for lumbar and leg pain, a significantly higher JOA score, and a significantly lower 2-year recurrence rate.

Conclusion

MRM combined with MRI is more beneficial to improve the prognosis of LDH patients after PTED.

Force Distribution Within Spinal Tissues During Posterior to Anterior Spinal Manipulative Therapy: A Secondary Analysis

Background

Previous studies observed that the intervertebral disc experiences the greatest forces during spinal manipulative therapy (SMT) and that the distribution of forces among spinal tissues changes as a function of the SMT parameters. However, contextualized SMT forces, relative to the ones applied to and experienced by the whole functional spinal unit, is needed to understand SMT’s underlying mechanisms.

Aim

To describe the percentage force distribution between spinal tissues relative to the applied SMT forces and total force experienced by the functional unit.

Methods

This secondary analysis combined data from 35 fresh porcine cadavers exposed to a simulated 300N SMT to the skin overlying the L3/L4 facet joint via servo-controlled linear motor actuator. Vertebral kinematics were tracked optically using indwelling bone pins. The functional spinal unit was then removed and mounted on a parallel robotic platform equipped with a 6-axis load cell. The kinematics of the spine during SMT were replayed by the robotic platform. By using serial dissection, peak and mean forces induced by the simulated SMT experienced by spinal structures in all three axes of motion were recorded. Forces experienced by spinal structures were analyzed descriptively and the resultant force magnitude was calculated.

Results

During SMT, the functional spinal unit experienced a median peak resultant force of 36.4N (IQR: 14.1N) and a mean resultant force of 25.4N (IQR: 11.9N). Peak resultant force experienced by the spinal segment corresponded to 12.1% of the total applied SMT force (300N). When the resultant force experienced by the functional spinal unit was considered to be 100%, the supra and interspinous ligaments experienced 0.3% of the peak forces and 0.5% of the mean forces. Facet joints and ligamentum flavum experienced 0.7% of the peak forces and 3% of the mean forces. Intervertebral disc and longitudinal ligaments experienced 99% of the peak and 96.5% of the mean forces.

Conclusion

In this animal model, a small percentage of the forces applied during a posterior-to-anterior SMT reached spinal structures in the lumbar spine. Most SMT forces (over 96%) are experienced by the intervertebral disc. This study provides a novel perspective on SMT force distribution within spinal tissues.

The Changes of Brain Function After Spinal Manipulation Therapy in Patients with Chronic Low Back Pain: A Rest BOLD fMRI Study

OBJECTIVE

To investigate the changes of regional homogeneity (Reho) values before and after spinal manipulative therapy (SMT) in patients with chronic low back pain (CLBP) through rest blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD fMRI).

METHODS

Patients with CLBP (Group 1, n = 20) and healthy control subjects (Group 2, n = 20) were recruited. The fMRI was performed three times in Group 1 before SMT (time point 1, TP1), after the first SMT (time point 2, TP2), after the sixth SMT (time point 3, TP3), and for one time in Group 2, which received no intervention. The clinical scales were finished in Group 1 every time before fMRI was performed. The Reho values were compared among Group 1 at different time points, and between Group 1 and Group 2. The correlation between Reho values with the statistical differences and the clinical scale scores were calculated.

RESULTS

The bilateral precuneus and right mid-frontal gyrus in Group 1 had different Reho values compared with Group 2 at TP1. The Reho values were increased in the left precuneus and decreased in the left superior frontal gyrus in Group 1 at TP2 compared with TP1. The Reho values were increased in the left postcentral gyrus and decreased in the left posterior cingulate cortex and the superior frontal gyrus in Group 1 at TP3 compared with TP1. The ReHo values of the left precuneus in Group 1 at TP1 were negatively correlated with the pain degree at TP1 and TP2 (r = -0.549, -0.453; p = 0.012, 0.045). The Reho values of the middle temporal gyrus in Group 1 at TP3 were negatively correlated with the changes of clinical scale scores between TP3 and TP1 (r = 0.454, 0.559; p = 0.044, 0.01).

CONCLUSION

Patients with CLBP showed abnormal brain function activity, which was altered after SMT. The Reho values of the left precuneus could predict the immediate analgesic effect of SMT.

Fast Independent Component Analysis Algorithm-Based Diagnosis of L5 Nerve Root Compression and Changes of Brain Functional Areas Using 3D Functional Magnetic Resonance Imaging

In this paper, the application of 3-dimensional (3D) functional magnetic resonance imaging (FMRI) in the diagnosis of the 5^th lumbar (L5) nerve root compression and brain functional areas in patients with lumbar disc herniation (LDH) was analyzed. The traditional fast independent component analysis (Fast ICA) algorithm was optimized based on the modified whitening matrix to establish a new type of Modified-Fast ICA (M-Fast ICA) algorithm that was compared with the introduced traditional Fast ICA and ICA. M-Fast ICA was applied to the 3D FMRI diffusion tensor imaging (DTI) evaluation of 65 patients with L5 nerve root pain due to LDH (group A) and 50 healthy volunteers (group B). The values of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in the lumbar nerve roots (L3, L4, L5, and the 1^st sacral vertebra (S1)) were recorded among subjects from the two groups. Besides, the score of edema degree in the lumbar nerve roots (L5 and S1) and activity of brain functional areas were also recorded among all subjects of the two groups. The results showed that the mean square error of M-Fast ICA was smaller than that of traditional Fast ICA and ICA, while its signal-to-noise ratio (SNR) was greater than that of Fast ICA and ICA (P < 0.05). The FA of L5 and S1 nerve roots in patients of group A was sharply lower than the values of group B, while the ADC of patients in group A was greater than that of the control group (P < 0.05). Besides, the score of edema in L5 and S1 nerve roots of patients in group A increased in contrast to group B (P < 0.05). The brain areas were activated after surgery including bilateral temporal lobe, left thalamus, splenium of corpus callosum, and right internal capsule. In conclusion, the 3D image denoising performance of M-Fast ICA optimized and constructed in this study was superior to that of the traditional Fast ICA and ICA. The FA of patients with L5 nerve root pain due to LDH decreased steeply, while the ADC increased dramatically. L5 nerve root pain caused by LDH resulted in changes in brain functional areas of the patients to inhibit the resting state default network activity, and the corresponding brain functional areas could be activated through treatment.

The application of key feature extraction algorithm based on Gabor wavelet transformation in the diagnosis of lumbar intervertebral disc degenerative changes

OBJECTIVE

Based on the theoretical basis of Gabor wavelet transformation, the application effects of feature extraction algorithm in Magnetic Resonance Imaging (MRI) and the role of feature extraction algorithm in the diagnosis of lumbar vertebra degenerative diseases were explored.

METHOD

The structure of lumbar vertebra and degenerative changes were respectively introduced to clarify the onset mechanism and pathological changes of lumbar vertebra degenerative changes. Most importantly, the theoretical basis of Gabor wavelet transformation and the extraction effect of feature information in lumbar vertebra MRI images were introduced. The differentiation effects of feature information extraction algorithm on annulus fibrosus and nucleus pulposus were analyzed. In this study, the data of lumbar spine MRI was randomly selected from the Wenzhou Lumbar Spine Research Database as research objects. A total of 130 discs were successfully fitted, and 109 images were graded by a doctor after observation, which was compared with the results of the artificial diagnosis. Through the comparison with the results of observation and diagnosis by professional doctors, the accuracy of feature extraction algorithm based on Gabor wavelet transformation in the diagnosis of lumbar vertebra degenerative changes was analyzed.

RESULTS

1. Compared with the results of the manual diagnosis, the accuracy of the classification method was 88.3%. In addition, the specificity (SPE), accuracy (ACC), and sensitivity (SEN) of the classification method were respectively 89.5%, 92.4%, and 87.6%. 2. The mutual information method and the KLT algorithm were utilized for vertebral body tracking. The maximum mutual information method was more effective in the case of fewer image sequences; however, with the increase of image frames, the accumulation of errors would make the tracking effects of images get worse. Based on the KLT algorithm, the enhanced vertebral boundary information was selected; the soft tissues showed in the obtained images were smooth, the boundary information of vertebral body was enhanced, and the results were more accurate.

CONCLUSION

The feature extraction algorithm based on Gabor wavelet transformation could easily and quickly realize the localization of the lumbar intervertebral disc, and the accuracy of the results was ensured. In addition, from the aspect of vertebral body tracking, the tracking effects based on the KLT algorithm were better and faster than those based on the maximum mutual information method.