The Effects of Side-Posture Positioning and Spinal Adjusting on the Lumbar Z Joints

Cramer, Gregory D.; Gregerson, Douglas; Knudsen, J.Todd; Hubbard, Bradley B.; Ustas, Leah M; Cantu, Joe A.

doi:10.1097/00007632-200211150-00008

Cited by 71 publications

(62 citation statements)

References 9 publications

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“…After insertion of an artificial disc, scar tissue may develop and take over the function of the ALL [15]. The gap size of the facet joints varies from patient to patient and is, in most cases, not exactly known [1]. The aim of the present investigation was to determine in a probabilistic finite element study the effects of implant position, implant ball radius, existence of scar tissue, and gap size in facet joints on intervertebral rotations, intradiscal pressures, and contact forces in the facet joints.…”

Section: Introductionmentioning

confidence: 99%

Effect of an artificial disc on lumbar spine biomechanics: a probabilistic finite element study

et al. 2008

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The effects of different parameters on the mechanical behaviour of the lumbar spine were in most cases determined deterministically with only one uncertain parameter varied at a time while the others were kept fixed. Thus most parameter combinations were disregarded. The aim of the study was to determine in a probabilistic finite element study how intervertebral rotation, intradiscal pressure, and contact force in the facet joints are affected by the input parameters implant position, implant ball radius, presence of scar tissue, and gap size in the facet joints. An osseoligamentous finite element model of the lumbar spine ranging from L3 vertebra to L5/S1 intervertebral disc was used. An artificial disc with a fixed center of rotation was inserted at level L4/L5. The model was loaded with pure moments of 7.5 Nm to simulate flexion, extension, lateral bending, and axial torsion. In a probabilistic study the implant position in anterior-posterior (ap) and in lateral direction, the radius of the implant ball, and the gap size of the facet joint were varied. After implanting an artificial disc, scar tissue may develop, replacing the anterior longitudinal ligament. Thus presence and absence of scar tissue were also simulated. For each loading case studied, intervertebral rotations, intradiscal pressures and contact forces in the facet joints were calculated for 1,000 randomized input parameter combinations in order to determine the probable range of these output parameters. Intervertebral rotation at implant level varies strongly for different combinations of the input parameters. It is mainly affected by gap size, ap-position and implant ball radius for flexion, by scar tissue and implant ball radius for extension and lateral bending, and by gap size and implant ball radius for axial torsion. For extension, intervertebral rotation at implant level varied between 1.4°and 7.5°. Intradiscal pressure in the adjacent discs is only slightly affected by all input parameters. Contact forces in the facet joints at implant level vary strongly for the different combinations of the input parameters. For flexion, forces are 0 in 63% of the cases, but for small gap sizes and large implant ball radii they reach values of up to 533 N. Similar results are found for extension with a maximum predicted force of 560 N. Here the forces are mainly influenced by gap size, implant ball radius and scar tissue. The forces vary between 0 and 300 N for lateral bending and between 0 and 200 N for axial torsion. The parameters that have the greatest effect in both loading cases are the same as those for extension. Intervertebral rotation and contact force in the facet joints depend strongly on the input parameters studied. The probabilistic study shows a large variation of the results and likelihood of certain values. Clinical studies will be required to show whether or not there is a strong correlation of parameter combinations that cause high facet joint forces and low back pain after total disc replacement.

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Section: Introductionmentioning

confidence: 99%

Effect of an artificial disc on lumbar spine biomechanics: a probabilistic finite element study

et al. 2008

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“…1) et a été observée chez le vivant en IRM. Elle persiste après manipulation [11]. Il y a donc dans un premier temps accumulation d'énergie puis lors du décrochage articulaire, restitution sous forme d'un mouvement à haute vélocité d'écartement des surfaces articulaires.…”

Section: Constatations Expérimentalesunclassified

Mode d’action des manipulations vertébrales

Maigne

2011

Lett Med Phys Readapt

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Les manipulations vertébrales agissent sur les différents composants de l'unité fonctionnelle vertébrale. Elles séparent les surfaces articulaires des articulations zygapophysaires, ce mouvement étant accéléré lors de la survenue du bruit de craquement. Elles semblent diminuer brièvement la pression intradiscale. Elles étirent en force les muscles paravertébraux, ce qui favorise leur relaxation par des méca-nismes encore mal explorés. Enfin, elles ont probablement un effet antalgique propre indépendant de la lésion en cause. Ces actions sont bénéfiques dans le cadre du traitement des douleurs vertébrales, mais elles sont toutes de courte durée. Un effet thérapeutique prolongé ne peut être expliqué que par une action réflexe telle que la rupture d'un cercle vicieux de type douleur-spasme-douleur ou par l'existence d'une lésion spécifique, dite lésion manipulable, non prouvée. Pour citer cette revue : Lett. Méd. Phys. Réadapt. 27 (2011). Mots clés Manipulation vertébrale · Lombalgie · Médecine manuelle · Chiropractie · OstéopathieAbstract Spinal thrust manipulations act on the different constituent elements of the vertebral motion segment. They separate the facet joint surfaces, with faster separation accompanied by a cracking noise. They appear to briefly lower the intradiscal pressure. They forcefully stretch the paraspinal muscles, thereby relaxing these muscles via an as yet poorly understood mechanism. They are also likely to have an inherent analgesic effect that is independent of the nature of the pain-causing lesion. While these actions are beneficial in the treatment of pain of vertebral origin, they are short-lived. A long-term therapeutic effect could be accounted for only in terms of a reflex phenomenon, such as the breaking of a vicious cycle of pain-spasmpain, or by the existence of a specific "manipulable" lesion, for which, however, no proof has been furnished to date. To cite this journal: Lett. Méd. Phys. Réadapt. 27 (2011).

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“…[10][11][12][13] The audible separation of these joints is associated with release of tissue adhesions, stimulation of the afferent nerve to the Z-joint and spinal muscles, and reflex neurologic and possibly immunologic sequelae and inflammatory chemical downregulation. [10][11][12][13][14] There are a percentage of patients in whom cavitation of the spinal facet joint is not possible because of spasm, guarding, and inhibitory mechanisms [15][16][17] despite meeting clinical criteria for its use. [18][19][20] Manipulation under anesthesia (MUA) is a pain management procedure using passive stretches combined with spinal manipulation under conscious sedation or general anesthesia with the goal of relieving musculoskeletal pain.…”

Section: Introductionmentioning

confidence: 99%

Manipulation Under Anesthesia for Lumbopelvic Pain: A Retrospective Review of 18 Cases

Taber¹,

James²,

Jacon³

2014

Journal of Chiropractic Medicine

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Objective: The purpose of this case series is to report the effects of manipulation under anesthesia (MUA) for patients with lumbopelvic (lumbar spine, sacroiliac and/or pelvic, hip) pain in an outpatient ambulatory/hospital-based setting. Methods: A retrospective chart review of cases treated at an outpatient ambulatory surgical center in New York and a general hospital in New York was performed. Patients with preand postintervention Oswestry Low Back Pain Disability Index (ODI) scores and lumbopelvic and hip complaints were included (N = 18). No intervention other than MUA was administered between the initial and follow-up ODI scoring. Scores on the ODI were assessed within 1 week prior to MUA and again within 2 weeks postprocedure. Results: Patients underwent 2 to 4 chiropractic MUA procedures over the course of 7 to 8 days as per National Academy of Manipulation Under Anesthesia physicians' protocols. Preprocedure ODI scores ranged from 38 to 76, with an average score of 53.4. Postprocedure scores ranged from 0 to 66, with an average score of 32.8. For each patient, ODI scores were lower after MUA, with an average decrease of 20.6. Sixteen of 18 patients experienced a clinically meaningful improvement in ODI score. No adverse reactions were reported. Conclusions: For 16 of the 18 patients with chronic lumbopelvic pain reported in this study, MUA showed clinically meaningful reduction in low back pain disability.

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The Effects of Side-Posture Positioning and Spinal Adjusting on the Lumbar Z Joints

Abstract: Spinal adjusting produced increased separation (gapping) of the Z joints. Side-posture positioning also produced gapping, but less than that seen with lumbar side-posture adjusting. This study helps to increase understanding about the mechanism of action for spinal manipulation.

Cited by 71 publications

References 9 publications

Effect of an artificial disc on lumbar spine biomechanics: a probabilistic finite element study

Effect of an artificial disc on lumbar spine biomechanics: a probabilistic finite element study

Mode d’action des manipulations vertébrales

Manipulation Under Anesthesia for Lumbopelvic Pain: A Retrospective Review of 18 Cases

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