"Side Posture Manipulation for Lumbar Intervertebral Disk Herniation," presented in the February, 1993 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT), reviews the current evidence supporting this procedure.
Among the many interesting and important points made in the paper by authors J. David Cassidy, DC, Haymo W. Theil, DC, and William H. Kirkaldy-Willis, MD, is this statement:
"By comparison, lumbar disks have as much, if not more, torsional strength than the cervical or thoracic disks(15) (Table 4). With all this in mind, it is hard to comprehend how the small amounts of rotation introduced during side posture manipulation could damage or irritate a healthy or herniated disk."The authors look at segmental localization of manipulation and state, "Subtle variations of manipulative techniques can be important in the treatment of disk herniation." The paper explores various forms of side-posture manipulation.
The paper concludes:
"The treatment of lumbar intervertebral disk herniation by side-posture manipulation is both safe and effective."Reference:
15. Sonada T. Studies for compression, tension and torsion of the human vertebral column, J Kyoto Pref Med Univ 1962; 71:659-702.
Editor's note: Anyone who performs this technique should consider ordering a reprint of this paper from Williams and Wilkins: 428 E. Preston St., Baltimore, MD 21202-39923.
Too Many Failed Backs in North America?
In a recent issue of Acta Orthopaedica Scandinavia, world renown orthopedist Alf Nachemson, MD, PhD, makes some interesting observations. His paper, "Lumbar Disc Herniation - Conclusions," discusses the criteria for selecting a patient for disc herniation intervention. It also talks frankly of the lack of research to support various invasive therapies.
But perhaps the most interesting statement is made concerning the number of disc herniation surgeries worldwide:
"International and national comparisons of frequencies of surgery for disk herniation may indicate that surgery is performed two to four times too often in the United States (Deyo et al., 1992). This means a substantial cost for society that is further increased by the number of so called failed backs. Again, international comparisons demonstrate a failed-back rate of around 15% in North America but no more than five percent in some western European societies (North et al., 1991)."Something to talk to your patients about before they make any serious decisions.
Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis and procedure. J Bone Joint Surg (Am) 1992; 74 (4): 536-43.
North RB, Campbell JN, James CS, Conover-Walker MK, Wang H, Piantadosi S, Rybock JD, Long DM. Failed back sugery syndrome: 5-year follow-up in 102 patients undegoing repeated operations. Neurosurgery 1991; 28 (5): 685-91.