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Subacute and chronic patients with MRI confirmed symptomatic disc herniation treated with spinal manipulation were statistically (and clinically) significantly more likely to report improvement at 3 months compared with the nerve root injection. This prospective cohort study had 104 patients, 52 patients treated with cervical nerve root injection (CNRI) and 52 patients treated with spinal manipulation by a chiropractor. Baseline numerical rating scale (NRS) pain data were collected. Three months after treatment, numerical rating score pain levels were recorded and overall “improvement” was assessed using the Patient Global Impression of Change scale. Responses that were “much better” or “better” were considered to be “improved.” The proportion of patients “improved” was calculated for each treatment method and compared. The NRS and NRS change scores for the 2 groups were compared at baseline and 3 months.  Results showed that there was no significant difference in outcomes between acute patients treated with cervical nerve root blocks and those treated with spinal manipulation at 3 months. However, when comparing the 3-month outcomes for the subacute/chronic patients, more than 78% of patients treated with SMT reported clinically relevant improvement compared with 37.5% of patients receiving a single CNRI. There were no adverse events for patients in either treatment group and the cost of treatment was similar for the 2 treatment procedures.

Reference: Peterson CK, Pfirrmann CW, Hodler J, Leemann S, Schmid C, Anklin B, Humphreys
BK. Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):210-7.

Podcast

Tue Secher Jensen

Tue Secher Jensen graduated from the University of Southern Denmark in 2002 and has been working as a researcher since his student years. After graduation, he worked as a chiropractic intern and as a chiropractor for a couple of years alongside his work as a research assistant. In 2009, he defended his PhD thesis on the prevalence, development and clinical value of Modic changes in the general population. From 2013 to 2016, he was employed as a senior researcher and clinical associate professor at the Spine Centre of Southern Denmark and since 2013 he has also been employed as a senior researcher at the Nordic Institute of Chiropractic and Clinical Biomechanics (NIKKB). Since 2017, Tue Secher Jensen has been employed at the Diagnostic Centre – Imaging Sector at the Regional Hospital in Silkeborg, Denmark, as a chiropractor doing research and reading spinal MRI. From 2018 to 2019 he was an associate professor at the Department of Clinical Medicine at Aarhus University. Tue Secher Jensen was recently (January 1st 2020) appointed, along with Lise Hestbaek (who has previously been on the podcast), as professors at the Department of Sports Science and Clinical Biomechanics at SDU.

Tue’s research has primarily focused on the clinical value of MRI findings in people with back pain. In recent years his research focus has shifted more towards clinical guidelines, knowledge translation and implementation.

See more of Tue’s research at researchgate.net.

The articles we discuss in this episode include:

1. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.
  Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG.
  AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. Review.
  PMID: 25430861 [PubMed – indexed for MEDLINE] Free PMC Article
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2. MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis.
  Brinjikji W, Diehn FE, Jarvik JG, Carr CM, Kallmes DF, Murad MH, Luetmer PH.
  AJNR Am J Neuroradiol. 2015 Dec;36(12):2394-9. doi: 10.3174/ajnr.A4498. Epub 2015 Sep 10. Review.
  PMID: 26359154 [PubMed – indexed for MEDLINE] Free Article
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3. Magnetic resonance imaging findings as predictors of clinical outcome in patients with sciatica receiving active conservative treatment.
  Jensen TS, Albert HB, Sorensen JS, Manniche C, Leboeuf-Yde C.
  J Manipulative Physiol Ther. 2007 Feb;30(2):98-108.
  PMID: 17320730 [PubMed – indexed for MEDLINE]
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4. Natural course of disc morphology in patients with sciatica: an MRI study using a standardized qualitative classification system.
  Jensen TS, Albert HB, Soerensen JS, Manniche C, Leboeuf-Yde C.
  Spine (Phila Pa 1976). 2006 Jun 15;31(14):1605-12; discussion 1613.
  PMID: 16778696 [PubMed – indexed for MEDLINE]
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5. Modic changes, possible causes and relation to low back pain.
  Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C.
  Med Hypotheses. 2008;70(2):361-8. Epub 2007 Jul 10.
  PMID: 17624684 [PubMed – indexed for MEDLINE]
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6. Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain.
  Jensen TS, Karppinen J, Sorensen JS, Niinimäki J, Leboeuf-Yde C.
  Eur Spine J. 2008 Nov;17(11):1407-22. doi: 10.1007/s00586-008-0770-2. Epub 2008 Sep 12. Review.
  PMID: 18787845 [PubMed – indexed for MEDLINE] Free PMC Article
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7. Modic changes-Their associations with low back pain and activity limitation: A systematic literature review and meta-analysis.
  Herlin C, Kjaer P, Espeland A, Skouen JS, Leboeuf-Yde C, Karppinen J, Niinimäki J, Sørensen JS, Storheim K, Jensen TS.
  PLoS One. 2018 Aug 1;13(8):e0200677. doi: 10.1371/journal.pone.0200677. eCollection 2018.
  PMID: 30067777 [PubMed – indexed for MEDLINE] Free PMC Article
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8. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy.
  Albert HB, Sorensen JS, Christensen BS, Manniche C.
  Eur Spine J. 2013 Apr;22(4):697-707. doi: 10.1007/s00586-013-2675-y. Epub 2013 Feb 13.
  PMID: 23404353 [PubMed – indexed for MEDLINE] Free PMC Article
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