Treatment Of Spinal Pain Research Articles

Radiofrequency ablation near the bone-muscle interface alters soft tissue lesion dimensions.

Radiofrequency (RF) lesions are safe and effective in the treatment of spine pain; however, models developed to study factors affecting lesion dimensions have been performed in homogeneous media that may not accurately simulate human anatomy and electrophysiology. We present a novel ex vivo porcine model for performing RF lesion studies and report the influence of bone on projection of RF ablation lesions into soft tissue. Radiofrequency lesions were performed in porcine rib specimens using monopolar 18-gauge, 10-mm straight active tip cannula, with a lesion temperature of 80°C for 150 seconds. Ten lesions were performed in pure porcine muscle tissue and abutting porcine rib bone with surrounding muscle. Lesions were exposed with dissection and measured with digital calipers. Maximal effective lesion radius approximately doubled against the bone compared with the pure muscle group (mean, 5.65 mm [95% CI, 5.43-5.87 mm] vs 2.68 mm [95% CI, 2.55-2.81 mm], P < .0001), although this was seen only in a vertical direction and not horizontally. In addition, the prelesion and postlesion impedance of the bone-muscle interface was consistently higher than the muscle-only interface (mean, 165.6 Ohm [95% CI, 146.6-184.6 Ohm] vs 137.8 Ohm [95% CI, 135.5-140.1 Ohm], P = 0.004; 144.3 Ohm [95% CI, 134.3-154.3 Ohm] vs 124.3 Ohm [95% CI, 119.3-129.3 Ohm], P = 0.001). Other dimensions and estimated volume were not significantly different. Bone adjacent to RF lesions alters the surrounding electrophysiological environment causing RF lesions to project further perpendicularly from the needle axis, vertically to bone, than previously expected. This phenomenon should be considered in the future modeling and clinical practice of RF.

Does inter-vertebral range of motion increase after spinal manipulation? A prospective cohort study

281 Branney and Breen set out to examine hypo-mobility detected by palpation as a basis for manipulative treatment of patients suffering neck pain, and the impact of manipulative treatment on IV-RoM and patient reported outcomes. In order to achieve this they designed a prospective cohort study of patients with nonspecific neck pain and healthy controls matched for age and gender. A relatively new technology for the objective measurement of IV-RoM was the key outcome measure. Quantitative fluoroscopy (QF) can be used to track and measure vertebral motion by computer analysis of real time fluoroscopic images, in this case recorded at 15 frames per second. Thirty participants suffering from neck pain and 30 asymptomatic participants were recruited. Cervical flexion and extension IV-RoM for spinal segments 1-6 were examined by palpation and recorded. The same motion was then assessed using QF to produce baseline data, and then re-assessed 4 weeks later for all participants. Over the 4 week period the symptomatic participants received up to 12 neck manipulations as part of a chiropractic management plan which focused on HVTs as the primary intervention. Symptomatic participants also completed various self-reported outcomes measures (11-point numerical rating scale for pain, neck disability index, EuroQol EQ5L, and the patient global impression of change) at baseline and 4 week follow-up. The results confirmed the high accuracy and repeatability of QF for the measurement of IV-RoM. There was no difference between the numbers of hypo-mobile segments in symptomatic participants compared to controls, and there was no agreement between palpation and QF in detecting hypo-mobile segments. While overall the neck pain participant’s symptoms improved, there was no correlation between increase in IV-RoM and patient reported outcomes after the course of manipulations. There was a modest correlation between the number of manipulations received and the number of levels at which IV-RoM increased, but it should be noted that almost all the segments at which IV-RoM increased already had normal mobility (measured by QF) before the application of manipulations. In their brief discussion of these results Branney and Breen create a context for their findings by highlighting research which has supported the notion that neck pain and cervical range of motion are intimately linked on a mechanical level, and hint that manipulation has mechanical effects on IV-RoM of importance for the management of neck pain. However, altered spinal motion in neck pain sufferers may of course be due to non-mechanical factors (e.g. fear avoidance). Seen in this light, their results in fact building upon previous studies (see Seffinger et al. for a review) that have helped deconstruct the role that palpated inter-vertebral hypo-mobility plays in the diagnosis and treatment of spinal pain. These results should further encourage clinicians in resisting the urge to manage their patient’s spinal pain based solely on biomechanical and pathoanatomical “findings”. Numerous other neurological and psychosocial factors contribute to a patient’s experience of pain and disability and should not be placed second in line to supposed joint hypo-mobility and other unreliable assessments in justifying and directing the application of manual therapy interventions such as HVT.

Epidural steroid injection for spinal pain

Spinal pain is one of the most common complaints of patients and making an economic burden on society. The worldwidelifetime prevalence of lower back pain was reported as 84%. Most general physicians, as well as spine surgeons, commonlyencountered to the diagnostic and management strategy for spinal pain. Currently, nonsurgical invasive treatment includinginjection therapy before surgery had been routine management option. The epidural injections with or without corticosteroid wasproven to be effective for spinal pain, especially with radiculopathy, in short term period. The long term effect and combineduse of corticosteroid are under debate. Further rationalized studies for these debates should be conducted. To help the doctorsin choosing rationalized nonsurgical treatment methods for spinal pain, this study present the evidence based effectiveness ofepidural injections and comprehensive reviews of current trends for corticosteroids in use for spinal pain treatment.

I60. The Myths and Mysteries of Invasive Treatment for Spinal Pain and Nerve Root Pain

I60. The Myths and Mysteries of Invasive Treatment for Spinal Pain and Nerve Root Pain

Intravascular Flow Detection During Transforaminal Epidural Injections: A Prospective Assessment

Background: Transforaminal epidural steroid injections (TFESI) are a mainstay in the treatment of spine pain. Though this commonly performed procedure is generally felt to be safe, devastating complications following inadvertent intra-arterial injections of particulate steroid have been reported. The use of digital subtraction angiography (DSA) has been suggested as a means of detecting intra-arterial needle placements prior to medication injection. Objective: To examine the efficacy of DSA in detecting intra-arterial needle placements during TFESI. Study Design: Prospective cohort study evaluating the impact of DSA on detecting intra-arterial needle placements during TFESI. Methods: We enrolled 150 consecutive patients presenting to a university-affiliated spine center with discogenic and/or radicular symptoms affecting the cervical, lumbar, and sacral regions. For each injection, prior to imaging with DSA, traditional methods for vascular penetration detection were employed, including the identification of blood in the needle hub (flash), negative aspiration of blood prior to injection, and live fluoroscopic injection of contrast. Once these tests were performed and negative for signs of intra-arterial needle placement, DSA imaging was utilized prior to medication administration for identification of vascular flow. Results: A total number of 222 TFESI were performed, 41 injections at the cervical levels (18.47%), 113 at the lumbar levels (50.9%), and 68 at the sacral levels (30.36%). Flash was observed in 13 injections performed (5.85% of the total number of injections): one (0.45%) in the cervical, 2 (0.9%) in the lumbar, and 10 (4.5%) in the sacral levels. In 11 TFESI blood aspiration was obtained (4.95% of all injections): 3 (1.3%) in cervical, 4 (1.8%) in lumbar, and 4 (1.8%) in sacral injections. Live fluoroscopy during contrast injection detected 46 (20.72%) intravascular flow patterns: 7 (3.1%) cervical, 17 (7.6%) lumbar, and 22 (9.9%) sacral. DSA identified an additional 5 intravascular injections after all previous steps had resulted in negative vascular penetration signs, which accounted for 2.25% of all injections. Limitations: This is a prospective, single-center study with a relatively small number of patients and no control group. Conclusion: DSA detected additional 5.26% intravascular needle placements following traditional methods. Our findings also support other studies that conclude TFESI are generally a safe procedure. We recommend that special attention should be paid to the sacral injections as vascular penetration was statistically higher than at other levels. Key words: Digital subtraction angiography, transforaminal epidural steroid injections

On the Fabric of the Human Body and Modern Ultrasound Imaging

Andreas Vesalius1 (1514–1564), Professor of Anatomy at the University of Padua, Imperial Physician to Holy Roman Emperor Charles V, and author of the seven-volume De Humani Corporis Fabrica (On the Fabric of the Human Body), is noted for his hands-on direct observation of human anatomy and the meticulous drawings of his work he prepared for his students. In the current era of genomics and proteomics, the study of basic human anatomy may seem antiquated and unimportant. However, for interventional pain treatments, precise understanding of the relevant anatomy remains the foundation for safety and effectiveness. In the field of pain medicine, the present-day physician and anatomist Nikolai Bogduk, M.D., Ph.D. (Professor, University of Newcastle, Newcastle, Australia) advanced our knowledge of the sensory innervation of the vertebral column and then built on that work to demonstrate the safe and effective use of radiofrequency treatment for spinal pain.2 Our knowledge of anatomy and how it relates to many painful conditions remains inadequate. We perform interventions for sacroiliac joint pain routinely, yet the innervation of the sacroiliac joint and how to use our knowledge of that anatomy remain the center of controversy.3 In this edition of Anesthesiology, van Eerd et al.4 in Maastricht present a meticulous and detailed study on the sonographic anatomy and landmarks of the cervical spine. They constructed an anatomical model of the cervical spine and a laser-precise, three-dimensional measurement device that allowed them to correlate ultrasound images and specific gross anatomical features of the spine. With this model, they developed a clear and reproducible technique for accurately identifying each of the cervical vertebral levels using ultrasound. Test–retest analysis demonstrated that their technique identifying each cervical vertebral level with ultrasound is extremely reproducible. They describe useful and distinct sonographic landmarks: the cranial base, the mastoid process, the arch of C1, the transverse process of C1, and several more. They note that C6 can be distinguished from C7 on ultrasound because C6 has both an anterior and posterior tubercle and C7 has only a posterior tubercle. They also confirmed that these same landmarks are visible in vivo. Throughout their article, the authors provide high-quality sonographic images and corresponding anatomic drawings of the cervical spine that are clear and instructive. Although others have provided some description of the sonographic anatomy,5,6 this new article stands out for its precision, rigor, and reproducibility. Their anatomic work sets the stage for meaningful application of ultrasound for image-guided needle placement during cervical interventions. Equally important, their model and measuring device can help us to provide better training in use of ultrasound.Caution is in order. We cannot assume that van Eerd’s findings can be generalized to all humans. They used a single human cervical vertebral column embedded in a medium that allowed for realistic ultrasonographic imaging. They and others will likely expand on this work by assuring that their findings can be generalized to populations and used in performing treatments like radiofrequency treatment of the cervical facets. We will also have to learn how their recommendations must be modified to account for common anatomic variations. This work describes only the bony anatomy, but a major advantage of ultrasound is the ability to visualize vessels, nerves, and other relevant soft tissue structures. Thus, a much needed extension of this work will be to develop ultrasound techniques that incorporate descriptions of all relevant bony and soft tissue structures and how they are best imaged. For now, we applaud van Eerd et al. for their careful study, like Vesalius, of basic human anatomy to guide the optimal use of ultrasound to visualize the cervical spine, and we encourage others to return to the anatomy lab as they investigate how best to apply modern imaging techniques in clinical practice.

Radiofrequency Ablation for the Treatment of Spine Pain

Radiofrequency Ablation for the Treatment of Spine Pain

Straight chiropractic philosophy as a barrier to Medicare compliance: a discussion of 5 incongruent issues

ObjectiveThe purpose of this commentary is to discuss potential 5 factors within straight chiropractic philosophy and practice that may prevent Medicare compliance. DiscussionThe national Medicare Benefit Policy Manual and the Florida Local Coverage Determination were reviewed to identify documentation and conceptual issues regarding chiropractic practice. Five Medicare positions were contrasted with tenets of straight chiropractic philosophy. Based on Medicare’s documentation requirements, Medicare defines subluxation and chiropractic practice from the perspective of treating spinal pain and related functional disability. In contrast, traditional straight chiropractic philosophy is not based on the treatment of spinal pain and disability or other symptomatic presentations. In this context, 5 potential areas of conflict are discussed. ConclusionThe Medicare version of chiropractic practice is not consistent with traditional straight chiropractic philosophy, which may play a role in preventing Medicare compliance. The chiropractic profession may need to consider the fashion in which “philosophy” as it relates to technique and practice is presented to students and doctors to facilitate compliance with the documentation requirements of Medicare.

Spinal Injections for the Diagnosis and Treatment of Spinal Pain

To provide a review of the medical literature and practical experience in the diagnosis, history, and physical examination of the spine with emphasis on the administration of spinal injections and their role in the treatment of painful spinal conditions.

The objective evaluation of effectiveness of manual treatment of spinal function disturbances

SummaryBackgroundThe aim of this paper is the evaluation of effectiveness of manual therapy in the treatment of functional disturbances of the spine.Material/MethodsThe study subjects were 40 persons aged 45–60 years, in whom degenerative changes in intervertebral discs and physical limitations within the spine were found (NMR), which were manifested as pain. Subjects were randomly divided into 2 groups of 20 persons each. The first group went on a monthly rehabilitation tour, where the manual therapy methods were applied. The second group was treated by means of physical methods. In order to verify the results of effectiveness of the therapies, the examination of the sectional mobility and the evaluation of the spinal curvatures before and after the completion of the therapy were made by means of a tensiometric electrogoniometer.ResultsThe percentage differences in significance result from the lower value of parameter t1 in the group of persons treated physically. The dynamics of changes in the parameters in the sectional mobility in both tested groups was highest in the cervical and lumbar spine. The manually treated group had greater dynamics of changes in functional parameters of the spine.ConclusionsManual therapy is an effective method for treatment of functional changes and early structural changes within the spine, and may be used as supplementary therapy in relation to the standard model of treatment of spinal pain.

Spine-area pain in military personnel: a review of epidemiology, etiology, diagnosis, and treatment

Nonbattle illnesses and injuries are the major causes of unit attrition in modern warfare. Spine-area pain is a common disabling injury in service members associated with a very low return-to-duty (RTD) rate. To provide an overview of the current understanding of epidemiology, possible causes, and relative prognosis of spine-area pain syndromes in military personnel, including a discussion of various treatment options available in theaters of operation. Literature review. Search focusing on epidemiology, etiology and associative factors, and treatment of spinal pain using electronic databases, textbooks, bibliographic references, and personal accounts. Spine-area pain is the most common injury or complaint "in garrison" and appears to increase during training and combat deployments. Approximately three-quarters involve low back pain, followed by cervical and midback pain syndromes. Some predictive factors associated with spine-area pain are similar to those observed in civilian cohorts, such as psychosocial distress, heavy physical activity, and more sedentary lifestyle. Risk factors specific to military personnel include concomitant psychological trauma, g-force exposure in pilots and airmen, extreme shock and vibration exposure, heavy combat load requirements, and falls incurred during airborne, air assault, and urban dismounted ground operations. Effective forward-deployed treatment has been difficult to implement, but newer strategies may improve RTD rates. Spine-area pain syndromes comprise a major source of unit attrition and are often the result of duty-related burdens incurred during combat operations. Current strategies in theaters of operation that may improve the low RTD rates include individual and unit level psychological support, early resumption of at least some forward-area duties, multimodal treatments, and ergonomic modifications.

Accountable disease management of spine pain

The health care landscape has changed with new legislation addressing the unsustainable rise in costs in the US system. Low-value service lines caring for expensive chronic conditions have been targeted for reform; for better or worse, the treatment of spine pain has been recognized as a representative example. Examining the Patient Protection and Affordable Care Act and existing pilot studies can offer a preview of how chronic care of spine pain will be sustained. Accountable care in an organization capable of collecting, analyzing, and reporting clinical data and operational compliance is forthcoming. Interdisciplinary spine pain centers integrating surgical and medical management, behavioral medicine, physical reconditioning, and societal reintegration represent the model of high-value care for patients with chronic spine pain.

Tackling the Technical Challenges That Hinder the Success of Facet Joint Radiofrequency Treatment for Spinal Pain

Tackling the Technical Challenges That Hinder the Success of Facet Joint Radiofrequency Treatment for Spinal Pain

Adapted reflextherapy – a treatment for spinal pain and whiplash injury

Adapted reflextherapy – a treatment for spinal pain and whiplash injury

Low-Back and Neck Pain Diagnosis and Treatment

Back and neck pain are symptoms, often complaints, and sometimes causes of disability, but they are not diseases. These distinctions are critical to understanding the personal and societal impact of back and neck pain and our opportunities to discover new ways to reduce their impact. This article briefly describes current diagnosis and treatment of spinal pain, the relationship between pain and disability, and the challenges in prioritizing our resource allocations between curing pain problems and reducing disability.

A Cost-utility Analysis of Chronic Spinal Pain Treatment Outcomes: Converting SF-36 Data Into Quality-adjusted Life Years

The present retrospective case review study sought to analyze the cost-utility, expressed in cost/quality-adjusted life years (QALY), of current chronic spinal pain treatments. In addition, it expands upon previously published data evaluating the efficacy of interdisciplinary pain management in relation to medication management. A recently developed algorithm was used to calculate QALYs using SF-36, v. 1 responses for 121 patients receiving treatment for chronic spinal pain at a pain rehabilitation center. Treatment groups evaluated were: (1) interdisciplinary program completers who received medication management and supplementary anesthetic procedures; (2) interdisciplinary program completers receiving medication management but not anesthetic procedures; (3) patients receiving medication management alone; and (4) patients receiving medication management with supplemental anesthetic procedures. Assessments were conducted at pretreatment and 6 months after the initiation of treatment. One-way analyses of covariance indicated that patients who participated in an interdisciplinary pain management program, which included medication management, psychotherapy, group education, and physical therapy, reported significantly less impairment in daily activities of living, less subjective experience of pain, and a higher quality of life and more preferred health state at the completion of their treatment phase, relative to patients receiving medication with or without anesthetic procedures. In addition, improvements in all outcome measures between pretreatment and posttreatment were significantly greater for those patients completing the interdisciplinary component of treatment. Cost-utility analyses revealed that the interdisciplinary treatment alone group was cost-saving, relative to the medication and procedures alternative, suggesting the former modality was both less costly and more effective than the latter. Average cost-utility ratios for both interdisciplinary treatment groups, ranging from 57,627 dollars /QALY to 75,885 dollars /QALY, were within established cost-effective parameters (20,000 dollars to 100,000 dollars /QALY, generally considered a good value), whereas cost-utility ratios for the standard care treatment groups were not interpretable because of a decrease in QALYs from pretreatment to posttreatment.

(843): A cost-utility analysis of conservative chronic spinal pain management

The present retrospective case review study sought to analyze the cost-utility, expressed in Cost/Quality-adjusted life years (QALYs), of current conservative chronic spinal pain treatments, as well as the QALY’s value as a clinically informative outcome measure. In addition, it expands upon previously published data evaluating the efficacy of interdisciplinary pain management, relative to medication management, in reducing the quantity and category of medication use. A recently developed algorithm was used to calculate QALYs using SF-36, v. 2 responses for 121 patients receiving treatment for chronic spinal pain at a pain rehabilitation center. Treatment groups evaluated were: (1) interdisciplinary program completers who also received medication management and supplementary anesthetic procedures; (2) interdisciplinary program completers also receiving medication management, but not anesthetic procedures; (3) patients receiving medication management alone; and (4) patients receiving medication management with supplemental anesthetic procedures. Assessments were conducted at pre-treatment and six-months after the initiation of treatment. Cost-utility analyses revealed that the interdisciplinary treatment alone group was cost-saving, relative to the medication and procedures alternative, suggesting the former modality was both less costly and more effective than the latter. Average cost-utility ratios for both interdisciplinary treatment groups, ranging from $57,627/QALY to $75,885/QALY, were within established cost-effective parameters ($20,000 to $100,000/QALY, generally considered a good value), while cost-utility ratios for the standard care treatment groups were not interpretable due to a decrease in QALYs from pre-treatment to post-treatment. Furthermore, pre- and post-treatment QALYs significantly correlated with well-developed measures of pain experience and functional disability, highlighting the QALY’s clinical utility as a measurement of patient health and well-being. Finally, post-treatment differences in the patients’ medication use were revealed among the four conservative spinal pain treatment groups. The present retrospective case review study sought to analyze the cost-utility, expressed in Cost/Quality-adjusted life years (QALYs), of current conservative chronic spinal pain treatments, as well as the QALY’s value as a clinically informative outcome measure. In addition, it expands upon previously published data evaluating the efficacy of interdisciplinary pain management, relative to medication management, in reducing the quantity and category of medication use. A recently developed algorithm was used to calculate QALYs using SF-36, v. 2 responses for 121 patients receiving treatment for chronic spinal pain at a pain rehabilitation center. Treatment groups evaluated were: (1) interdisciplinary program completers who also received medication management and supplementary anesthetic procedures; (2) interdisciplinary program completers also receiving medication management, but not anesthetic procedures; (3) patients receiving medication management alone; and (4) patients receiving medication management with supplemental anesthetic procedures. Assessments were conducted at pre-treatment and six-months after the initiation of treatment. Cost-utility analyses revealed that the interdisciplinary treatment alone group was cost-saving, relative to the medication and procedures alternative, suggesting the former modality was both less costly and more effective than the latter. Average cost-utility ratios for both interdisciplinary treatment groups, ranging from $57,627/QALY to $75,885/QALY, were within established cost-effective parameters ($20,000 to $100,000/QALY, generally considered a good value), while cost-utility ratios for the standard care treatment groups were not interpretable due to a decrease in QALYs from pre-treatment to post-treatment. Furthermore, pre- and post-treatment QALYs significantly correlated with well-developed measures of pain experience and functional disability, highlighting the QALY’s clinical utility as a measurement of patient health and well-being. Finally, post-treatment differences in the patients’ medication use were revealed among the four conservative spinal pain treatment groups.

Summary Statement

The problems of neurologic injury, disc degeneration, and spinal pain are germane to all physicians who manage spinal deformities. In accordance with this Focus Issue’s theme of “Innovative Treatment Options for Spinal Deformity,” the prior four papers describe novel technologies that encompass biologic, biomechanical, and biophysical approaches. In the area of spinal cord injury, several experimental approaches have shown promise for promoting neurologic recovery in animal models and are emerging as potential therapies ready for human clinical trials. The urgency with which an effective treatment for these devastating injuries are needed, however, should not circumvent the requirement for all potential therapies to undergo rigorous safety and efficacy evaluation in well-designed, controlled clinical trials before their acceptance as a valid treatment in humans. Intervertebral disc matrix degradation and cellular loss are integral to the process of disc degeneration. In recent years, a variety of biologic strategies have been suggested to repair the degenerative disc. The current data suggest that a variety of cell types have the ability to survive transplantation to the disc and produce matrix proteins for at least short periods of time in animal models. At present, it remains unclear whether a cellular approach is capable of producing meaningful, long-term disc repair in humans. A significant hurdle in this line of research is the lack of understanding of the specific etiology of spinal pain, and the elusive correlation between pain and the histologic and morphologic signs of disc degeneration. Substantial future research is required to determine the efficacy of a cellular approach to disc repair and ultimately the effect of such a strategy on symptomatic disc degeneration in humans. Biophysical methods such as heat and ultrasound have been studied for the treatment of spinal pain, although the mechanisms of action and the underlying short- and long-term efficacy of biophysical methods remain undefined. Cryotherapy, which is at a very preliminary stage of investigation, represents a potential, novel approach treatment for spinal pain. Substantial research will be required to characterize the safety and biologic effects of cryotherapy before consideration of clinical trials. Within this section, cervical disc replacement is the farthest along the path to clinical adoption with several FDA IDE trials in progress across North America. Despite the current enthusiasm for motion preservation in the spine, it is not yet clear whether cervical disc replacement will produce a true clinical benefit when compared with cervical fusion. It is worth remembering that anterior cervical decompression and fusion has traditionally been considered one of the most successful of spine surgeries. New complications related to cervical disc replacement are likely to occur, and the longevity of the implant and consequences of wear debris are unknown.

A systematic review of efficacy of McKenzie therapy for spinal pain

A systematic review of randomised clinical trials was conducted to investigate the efficacy of McKenzie therapy in the treatment of spinal pain. Databases searched included DARE, CINAHL, CENTRAL, EMBASE, MEDLINE and PEDro. To be eligible for inclusion trials had to provide treatment according to McKenzie principles and report on one of the following outcomes: pain, disability, quality of life, work status, global perceived effect, medication use, health care contacts, or recurrence. Six trials were found to be eligible, all comparing McKenzie therapy to a comparison treatment. These included NSAIDS, educational booklet, back massage and back care advice, strength training, and spinal mobilisation and general exercises. The data from five lumbar trials were pooled at short term (less than three months) and from three at intermediate (3-12 months) follow-up. At short term follow-up the McKenzie therapy provided a mean 8.6 point greater pain reduction on a 0 to 100 point scale (95% CI 3.5 to 13.7) and a 5.4 point greater reduction in disability on a 0 to 100 point scale (95% CI 2.4 to 8.4) than comparison. At intermediate follow-up, relative risk of work absence was 0.81 (0.46 to 1.44) favouring McKenzie, however the comparison treatments provided a 1.2 point greater disability reduction (95% CI -2.0 to 4.5). In the one cervical trial, McKenzie therapy provided similar benefits to an exercise program. The results of this review show that for low back pain patients McKenzie therapy does result in a greater decrease in pain and disability in the short term than other standard therapies. Making a firm conclusion on low back pain treatment effectiveness is difficult because there are insufficient data on long term effects on outcomes other than pain and disability, and no trial has yet compared McKenzie to placebo or no treatment. There are also insufficient data available on neck pain patients.

Injections for the Diagnosis and Treatment of Spinal Pain

Injections for the Diagnosis and Treatment of Spinal Pain