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What is Manipulation Under Anesthesia?
This procedure, manipulation under anesthesia (MUA), is a non-invasive procedure increasingly offered for acute and chronic conditions, including: neck pain, back pain, joint pain, muscle spasm, shortened muscles, fibrous adhesions and long term pain syndromes. It is generally considered safe and is utilized to treat pain arising from the cervical, thoracic and lumbar spine as well as the sacroiliac and pelvic regions.
Manipulation under anesthesia uses a combination of specific short lever manipulations, passive stretches and specific articular and postural kinesthetic maneuvers in order to break up fibrous adhesions and scar tissue around the spine and surrounding tissue.
The manipulation procedures can be offered in any of the following ways:
The treatment is performed in a hospital or surgery center by licensed physicians with specialized training and certification specifically for the procedure. A team approach is required to have a safe and successful outcome.
The team includes the anesthesiologist, the prime physician/surgeon/chiropractor who performs the manipulation, and the first assistant, also a physician/chiropractor certified in manipulation under anesthesia. The procedure is commonly performed in a hospital or surgical center.
The combination of manipulation and anesthesia is not new, as this treatment has been part of the manual medical arena for more than 60 years.Manipulation Under Anesthesia is an established medical procedure with a CPT Code designate of 22505. This is noted in the American Medical Association's Current Procedural Terminology Publication.
Which patients should be considered for manipulation under anesthesia?
Certain neck, mid back, low back or other spinal conditions respond poorly to conventional care. One proposed theory for this is that, as a result of past or present injury, adhesions and scar tissue have built up around spinal joints and within the surrounding muscles and causes chronic pain.
Patients often undergo various treatments, such as physical therapy, chiropractic care, epidural injections, back surgery, or other treatments that do not address fibrous adhesions. Some patients feel temporarily better with these treatments, but their pain often returns.
In general, patients selected for manipulation under anesthesia are those who have received conservative care for six to eight weeks. If limited or no improvements in symptoms or objective findings have occurred, then manipulation under anesthesia may be an appropriate alternative.
Prior to treatment, protocols of diagnostic testing should document the nature of the diagnosis, support the need for treatment and eliminate questions of psychosocial factors that can influence pain responses. In addition to X-ray, MRI scan or CT scan, a musculoskeletal sonogram or nerve conduction velocity test may be ordered.
The proposed effects of
manipulation under anesthesia therapy include the following:
Indications and Contraindications
for chiropractic manipulation
In general, patients selected for manipulation under anesthesia have received a minimum of six to eight weeks of conservative care. Additionally, there are a number of specific indications and contraindications that need to considered prior to undertaking manipulation under anesthesia, including:
Contraindication to anesthesia as determined by current medical literature and is the responsibility of the licensed medical co-manager (anesthesiologist).
Contraindications to manual manipulation of high velocity, low velocity or soft tissue techniques as established by current literature relative to technique specific for articular derangements, bone weakening and destruction disorders, circulatory and cardiovascular disorders, or neurological disorders.
Specific contraindications to manipulation of the spine under anesthesia include:
Post Operative Care
The patient should experience an immediate increase in range of motion, even though there is usually some temporarily added muscle soreness similar to the feeling of having completed an aggressive exercise session. In cases involving symptoms caused by disturbance from adhesions and shortened tissues there should be a significant change, either immediately or within a short period following the procedures.
In efforts to minimize the reformation of adhesions, passive manipulation and active exercises are prescribed. Some use of additional therapies may also be prescribed, such as:
The most important post operative care is an active rehabilitation program, starting within one to two weeks after the manipulation under anesthesia procedure and lasting for a minimum of four to six weeks.
There are several research studies about the effectiveness of manipulation under anesthesia, including:
The medical literature demonstrates that for over forty years chronic neuromuscular skeletal conditions that have failed the conservative protocol may respond well to manipulation under anesthesia.
The overall effectiveness of spinal manipulation under anesthesia has been reported by researchers with success rates varying according to case selection criteria.
Diagnosis of herniated disc reported excellent to good results in:
60% - PC Colonna and ZB Friendenberg: 1949
64% - Merrill C Mensor, MD: 1949
60% - Donald Sielh, DC: 1963
Diagnosis of myofibrositis reported excellent to good results in:
96.3% - Donald Siehl, OD: 1963
75% - BR Krumhansi and CJ Nowacek: 1988
Manipulation Under Anesthesia References
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