Tag Archive for: nerve root injection

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Improvement in Cervical Disc Herniation Symptoms with Spinal Manipulation

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.

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Episode

071- Dr. Cesar Hincapie – Chiropractic, Lumbar Disc Herniations, Nerve Root Injections

Dr. Cesar Hincapie and I discuss his research involving chiropractic, lumbar disc herniations and nerve root injections. He describes the ongoing SALuBRITY trial which is the first-ever chiropractic randomized clinical trial funded by the Swiss National Science Foundation and is also partially funded by the European Centre for Chiropractic Research Excellence.

Dr. Cesar Hincapié completed his clinical training as a Doctor of Chiropractic (DC, 2003) at the Canadian Memorial Chiropractic College, in Toronto, Canada. While maintaining a clinical practice, he earned a MHSc (2008) and a PhD (2015) in epidemiology at the University of
Toronto. During his PhD, he was awarded a Canadian Institutes of Health Research Fellowship in knowledge translation. After several years of research, clinical, and teaching activities, Dr. Hincapié completed postdoctoral training in clinical trials and injury epidemiology at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital (University of Toronto affiliated academic hospital). In 2019, he was recruited to the University of Zurich as an International Chiropractic Research Fellow and served as head of clinical research within the Department of Chiropractic Medicine at Balgrist University Hospital and University of Zurich. As of August 2022, Cesar joined the Epidemiology, Biostatistics and Prevention Institute at the University of Zurich as Senior Scientist and Head of the Musculoskeletal Epidemiology Research Group.

The Musculoskeletal Epidemiology Research Group is an interdisciplinary research team focused on producing high quality and relevant research related to musculoskeletal and spine health and care. Their work applies a clinical epidemiological perspective to the area of musculoskeletal health and care. Dr. Hincapié is the principal investigator of the SALuBRITY randomised clinical trial, which is assessing the comparative effectiveness of spinal manual therapy and corticosteroid nerve root injection for the management of patients with sciatica.

Here is the video of our conversation.

Please see Dr. Hincapie’s researchgate.net profile here.

Here are the articles we discussed in this episode.

1.
Incidence of and risk factors for lumbar disc herniation with radiculopathy in adults: a systematic review.
Hincapié CA, Kroismayr D, Hofstetter L, Kurmann A, Cancelliere C, Raja Rampersaud Y, Boyle E, Tomlinson GA, Jadad AR, Hartvigsen J, Côté P, Cassidy JD.
Eur Spine J. 2025 Jan;34(1):263-294. doi: 10.1007/s00586-024-08528-8. Epub 2024 Oct 25.
PMID: 39453541 Free PMC article.
2.
‘Which treatment do you believe you received?’ A randomised blinding feasibility trial of spinal manual therapy.
Muñoz Laguna J, Kurmann A, Hofstetter L, Nyantakyi E, Braun J, Clack L, Bang H, Farshad M, Foster NE, Puhan MA, Hincapié CA; SALuBRITY Blinding Clinician Group.
Chiropr Man Therap. 2025 Jan 14;33(1):4. doi: 10.1186/s12998-024-00561-0.
PMID: 39810207 Free PMC article. Clinical Trial.
3.
Feasibility of blinding spinal manual therapy interventions among participants and outcome assessors: protocol for a blinding feasibility trial.
Muñoz Laguna J, Kurmann A, Hofstetter L, Nyantakyi E, Clack L, Bang H, Foster NE, Braun J, Puhan MA, Farshad M, Hincapié CA.
Pilot Feasibility Stud. 2024 May 2;10(1):70. doi: 10.1186/s40814-024-01492-6.
PMID: 38698433 Free PMC article.
4.
Swiss chiropractic cohort (Swiss ChiCo) pilot study: feasibility for a musculoskeletal cohort study conducted within a nationwide practice-based research network.
Lalji R, Hofstetter L, Kongsted A, von Wyl V, Braun J, Puhan MA, Hincapié CA; Swiss ChiCo Clinicians Group.
Eur Spine J. 2024 May;33(5):2068-2078. doi: 10.1007/s00586-024-08175-z. Epub 2024 Mar 13.
PMID: 38480624
5.

 

 

 

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047- Drs. Cindy Peterson and Kim Humphreys Discuss Disc Herniations, Neck Pain, Dizziness and Chronic Low Back Pain

Drs. Cindy Peterson and Kim Humphreys

Drs. Cindy Peterson and Kim Humphreys join me to talk about cervical and lumbar disc herniation comparative effectiveness studies involving spinal manipulation compared to nerve root injections. We also discuss spinal manipulation for neck pain with and without dizziness as well as for chronic low back pain.

Cynthia Peterson, RN, DC, DACBR, M.Med.Ed. has worked as a chiropractic radiologist, researcher and educator in 4 countries.  She retired from her positions as Professor and researcher, Radiology Department, Orthopaedic University hospital Balgrist and Professor, Chiropractic Medicine Programme, University of Zürich in 2017. Dr. Peterson has published numerous research studies in many journals including ‘Spine’, European Spine Journal, ‘American Journal of Roentgenology’, ‘JMPT’ and ‘Skeletal Radiology’.  She is currently a Visiting Professor for the Chiropractic Department in the Faculty of Health at the University of Johannesburg, South Africa and is the Quality Assurance Consultant for the European Council on Chiropractic Education.

Barry Kim Humphreys, BSc, DC, PhD, is Professor Emeritus, Faculty of Medicine, University of Zurich. He retired in July 2017, after 9 years as the first Professor for Chiropractic Medicine in Switzerland. During this time, Professor Humphreys was responsible for the development and accreditations of the chiropractic education program, research portfolio and teaching clinic within the university, medical faculty and teaching hospital. Professor Humphreys is a graduate of the University of British Columbia (BSc), Canadian Memorial Chiropractic College (DC), and the University of Southampton, UK (PhD). He has been Academic Dean, Anglo-European College of Chiropractic, Dean of Graduate Education and Research, CMCC and Professor, Chiropractic Medicine, University of Zurich. He has been active in research including chiropractic clinical outcome studies for back and neck pain, functional MRI studies of chronic pain patients and back pain in various gravitational environments (parabolic flight).

Please view Drs. Cindy Peterson and Kim Humphreys research at researchgate.net (Peterson) as well as at researchgate.net (Humphreys).

View all of the podcast episodes at chiropracticscience.com

Here are the articles we discuss in this episode:

1. 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.
  Peterson CK, Pfirrmann CW, Hodler J, Leemann S, Schmid C, Anklin B, Humphreys BK.
  J Manipulative Physiol Ther. 2016 Mar-Apr;39(3):210-7. doi: 10.1016/j.jmpt.2016.02.004. Epub 2016 Mar 31.
  PMID: 27040033 [PubMed – indexed for MEDLINE]
  Similar articles
2. Symptomatic magnetic resonance imaging-confirmed lumbar disk herniation patients: a comparative effectiveness prospective observational study of 2 age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections.
  Peterson CK, Leemann S, Lechmann M, Pfirrmann CW, Hodler J, Humphreys BK.
  J Manipulative Physiol Ther. 2013 May;36(4):218-25. doi: 10.1016/j.jmpt.2013.04.005. Epub 2013 May 22.
  PMID: 23706678 [PubMed – indexed for MEDLINE]
  Similar articles
3. Comparison of outcomes in neck pain patients with and without dizziness undergoing chiropractic treatment: a prospective cohort study with 6 month follow-up.
  Humphreys BK, Peterson C.
  Chiropr Man Therap. 2013 Jan 7;21(1):3. doi: 10.1186/2045-709X-21-3.
  PMID: 23295018 [PubMed] Free PMC Article
  Similar articles
4. An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment.
  Wirth B, Riner F, Peterson C, Humphreys BK, Farshad M, Becker S, Schweinhardt P.
  Chiropr Man Therap. 2019 Feb 5;27:6. doi: 10.1186/s12998-018-0225-8. eCollection 2019.
  PMID: 30766664 [PubMed – indexed for MEDLINE] Free PMC Article
  Similar articles
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