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Erschienen in:
31.03.2023 | Originalien
Changes in range of motion and neurological symptoms in patients with thoracolumbar junction syndrome treated with spinal manipulations
Erschienen in: Manuelle Medizin | Ausgabe 3/2023
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Objective
The aim of the study was to evaluate the results of treatment with high-velocity low-amplitude spinal manipulations (HVLA SM) in 246 patients with low back pain of thoracolumbar junction origin confirmed by segmental examination.
Background
The pain distribution in thoracolumbar junction syndrome (TLJS) corresponds to the branches of the spinal nerves arising from Th11-Th12-L1 segments. It is usually combined (in 86.5% of cases) with pain originating from the lower lumbar segments (L4-S1). The diagnosis is based mainly on clinical signs and is revealed by neurological and manual segmental examination.
Study design
Case series without a control group.
Methods
In the investigation were included 113 males (46%) with mean age of 43.9 ± 10.53 years and 133 females (mean age 45.3 ± 12.96 years). The Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) were used for evaluation of patients’ complaints. The range of motion (ROM) of lumbar spine and neurologic symptoms were examined. HVLA SM were performed on Th11-L1 segments. Assisted semi-indirect manipulations in rotation were used.
Results
At the end of treatment, the patients’ mean values for NPRS and ODI decreased significantly (p < 0.05) from 5.83 ± 0.13 to 1.15 ± 0.11 and 28.22% ± 0.55 to 8.82% ± 0.34, respectively. The measured mean value of forward bending fingertip-to-floor distance (FTFD) in centimeters decreased, with 6.87 ± 0.58 cm even after the first manipulation, reaching 9.4 ± 0.7 cm at the end of treatment. The same distances of left and right lateral bending were also reduced significantly. The sensory symptoms decreased significantly or disappeared entirely.
Conclusion
The ROM, pain, paresthesia, and hypoesthesia of patients with TLJS improved significantly or disappeared after the treatment with semi-indirect HVLA SM. The changes were most evident after the first manipulation. Improvement in all patients’ complaints and symptoms as a result of HVLA SM leads to lower disability. The statistically significant changes in ROM and sensory symptoms after the first manipulation support the hypothesis of the reversibility of the ailment (probably segmental dysfunction with facet joint origin) in TLJS.