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American Academy of Osteopathy Consensus Statement for Osteopathic Manipulation of Somatic Dysfunction under Anesthesia and Conscious Sedation. In the large case series undertaken by Siehl, manipulation of the dorsal (thoracic) spine under general anesthesia was rendered "occasionally", while 9% of patients required more than one procedure dose [28]. Once relaxed, the patient is gently stretched and fixations in the spine are released. Nevertheless, it is recognized that lack of protocol/evidence awareness, financial enticement, entrepreneurial motivations and/or clinician assuredness for MUA can contribute to decision making that fails to best meet the needs of individual patients. Dreyfuss P, Michaelsen M, Horne M: MUJA: manipulation under joint anesthesia/analgesia: a treatment approach for recalcitrant low back pain of synovial joint origin. Bremner RA: Manipulation in the management of chronic low backache due to lumbosacral strain. Rehabilitation After MUA. The analgesic/hypoalgesic effects of spinal manipulation have been discussed elsewhere [93, 97–101], as have the mechanical/physiological benefits of increased joint range of motion [91, 93, 100] and a reduction of articular adhesions [93]. R. S. D. WHO PERFORMS THE MUA PROCEDURE? Tosounidis T, Kanakaris N, Nikolaou V, Tan B, Giannoudis PV: Assessment of lateral compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?. Curvature of spine / scoliosis.

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These professionals are licensed and certified. What is Manipulation Under Anesthesia (MUA)? Chronic Neck and Low Back Pain – Amazing Procedure Helps in ONE Day. Scar tissue and fibrous adhesions can greatly restrict range of motion and cause pain. Lumbar or Thoracic Disc Displacement.

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I felt like a new person after I walked out of there". For manipulation under anesthesia, our sports chiropractor develops a comprehensive chiropractic care treatment plan to optimize results. In 2002 Palmieri et al demonstrate clinical efficacy of MUA performed in a series of three consecutive procedures. What should I expect during an MUA treatment? Centers for Disease Control and Prevention. Unresponsive to manipulation and adjustment when they are the treatment of choice. 1995, 18 (8): 537-46. Chronic disc conditions. According to the American Academy of Osteopathy (AAO), MUA "may be appropriate in cases of restrictions and abnormalities of function. " An intravenous catheter is inserted into the patient's arm and a board certified Anesthesiologist administers a small amount of anesthesia. Nevertheless, the newly established American Association of Manipulation Under Anesthesia Providers (AAMUAP) alternatively recommends an approach for determining single versus serial MUA on a pre-MUA basis [131].

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This will consist of therapeutic stretches, spinal manipulation, vibration therapy, and range-of-motion strengthening exercises. Spinal cord compression. Table 1 summarizes many of the clinical diagnoses traditionally reported and treated by MAM. Some conditions respond better than others. Maund E, Craig D, Suekarran S, Neilson A, Wright K, Brealey S, Dennis L, Goodchild L, Hanchard N, Rangan A, Richardson G, Robertson J, McDaid C: Management of frozen shoulder: a systematic review and cost-effectiveness analysis. There is a void of high quality published medical evidence to support the practice of universal MUA treatment of the entire axial spine in the management of a sole regional condition, when there are concomitant but comparatively innocuous complaints/physical findings of vertebral joint pain/dysfunction of other spinal regions. 2006, New York: McGraw-Hill, 13-30.

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2009, 11 (4): 247-53. In general, Dr. McKeigan selects patients for manipulation under anesthesia who have received conservative care for six to eight weeks. It's known that absent inflammation, spinal nerve root compression on its own does not cause pain, although physical signs of motor, deep tendon reflex and/or sensory deficits can occur [91, 92]. Why Does MUA Work So Well? Spinal MUA Post-Procedure Care. In addition, it has been reported that the types of spinal conditions most suitable for MUA are without clear-cut consensus, with various indications for MUA of the low back resting wholly upon the opinions and experiences of MUA practitioners. Moreover, clinical trials are necessary in qualifying the indications and appropriate parameters of such treatment, including criteria for patient candidacy and optimal procedure dose application. Manison AM: Chiropractic management using Cox cervical flexion-distraction technique for a disk herniation with left foraminal narrowing in a 64-year-old man. 1999, 22 (3): 166-70.

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This is not beneficial for the profession, and could theoretically jeopardize future patient access to the services that are integral to present day office-based chiropractic care. Consequently, any supportive medical evidence for the utilization of MUA to treat frozen shoulder or hip articulations does not serve as a clinical basis for the routine application of MUA to these extremity joints when rendered as an adjunctive form of care during the MUA management of a spine pain condition. Rehabilitation programs usually include electrostimulation, ultrasound, heating and massage as well as physical therapy exercises. Reportedly, this holds true even for injuries associated with rear-end vehicular collisions (with 20% of those cases selected for MUA) [38]. Physical therapy may include passive stretching, electrical stimulation, and/or cryotherapy (ie, cold therapy to help reduce inflammation and pain). The more recent West paper [31] offers no mention of this and does not address the potential therapeutic impact of the injection on the group of subjects that had received it relative to those who underwent MUA (conscious sedation) alone. Chronic recurrent neuromusculoskeletal dysfunction syndromes which result in a regular periodic treatment series that are always exacerbations of the same condition. Manipulation under anesthesia is a subspecialty procedure. Cassidy JD, Thiel HW, Kirkaldy-Willis WH: Side posture manipulation for lumbar intervertebral disk herniation. While the potential for patient complication with MUA exists regardless of the body region under treatment, the relative paucity of reported incidents or published case reports in this area [38, 132] appears to indicate that the risk for complication is considerably low with properly selected patients.

Levels of Evidence For Primary Research Question. Following MUA, in order to deter the reformation of vertebral joint and/or myofascial adhesions during the course of healing, both spinal manipulation and a continuance of the stretching/traction type techniques utilized during MUA are to be employed, in part, at each post-MUA follow-up visit to the doctor's office [5]. Gehlbach SH: Interpreting the Medical Literature. MUA can be instrumental in avoiding surgery for frozen shoulder. Loss Of Joint Range-of-motion. The treatment after your MUA is extremely important to your recovery. By lack of adherence to a more standardized means of selecting and applying all aspects of the procedure, chiropractors may place the future of MUA in jeopardy to the extent that patients who develop a need for the like may no longer have access. Nelson L, Aspegren D, Bova C: The use of epidural steroid injection and manipulation on patients with chronic low back pain. What Happens During an MUA Procedure? Our team includes a Board Certified Anesthesiologist, a Medical Physician and several chiropractors who perform the manipulation, and a nursing staff that is fully trained in "Pre and Post Operative" protocols. The problem with Mesa, AZ manipulations under anesthesia is that there is just not enough money to fund good quality clinical studies. For spine surgery, if a device manufacturer is charging $1, 000 for a single screw, they've got the money to throw around on a study or two. MUA is performed in an ASC (Accredited Surgery Center) under the controlled observation of a skilled Anesthesiologist.

Conditions responding poorly to other conservative treatments. What Conditions Respond Well to MUA? Additional information. MUA is completed in a private procedure room. MUA is not an invasive surgery and the actual procedure is very gentle. Haneline MT: Evidence-Based Chiropractic Practice. Many times this solely involves nonsurgical treatment modalities. This from someone who reads a LOT of medical literature. 2003, 25 (3): 18-26. There are no randomized controlled trials or published cohort studies on MUA management of specific diagnoses of the cervical or thoracic regions. Dr. McKeigan can provide MUA procedures to patients in the Cleveland area suffering from certain neck, mid back, low back or extremity conditions that have responded poorly to conventional care. WHAT IS MANIPULATION UNDER ANESTHESIA?

Dr. Grassi has more than 20 years experience specializing in the non-surgical and differential diagnosis of neuro-musculoskeletal disorders of the neck, back, and extremities; motor vehicle trauma; and musician injuries. Indications for MUA: - Chronic Headaches. The mere presence of clinical papers in the literature over an 80 year timespan does not summarily connote procedural efficacy. Strunce JB, Walker MJ, Boyles RE, Young BA: The immediate effects of thoracic spine and rib manipulation on subjects with primary complaints of shoulder pain. The American Academy of Osteopathy Journal. Gordon RC: An evaluation of the experimental and investigational status and clinical validity of manipulation of patients under anesthesia: a contemporary opinion. Eunice Kennedy Shriver National Institute of Child Health and Human Development.

To date, as part of the natural progression of clinical research [62], the MUA protocols routinely used by chiropractors have not been subjected to a single large-scale randomized controlled trial for any spinal condition or diagnosis so as to reveal the evidence of efficacy or in serving to support serial MUA over a single procedure dose. 2012, 19 (4): 329-31. Afterward the patient wakes up and is monitored by qualified personnel until discharge. 2 Digiorgi D. 2013;21(1):14. McCoy M: The Adjustment. This prevents the adhesions or spasms from returning (adhesions reform is 24-36 hours). For what may be considered one of the seminal references on the subject of MUA, Krumhansl and Nowacek reported that over a 6 year period a total of 190 MUA procedures were performed on 171 subjects [38]. Differences exist in the type, route and mode of action of the medication agents administered from one procedure to another.

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