Spinal manipulation under anesthesia: a narrative review of the literature and commentary

DiGiorgi, Dennis

doi:10.1186/2045-709X-21-14

Chiropractic & Manual Therapies

Table 2 Synopsis of the routinely cited or reviewed published research papers on MAM of the spine

From: Spinal manipulation under anesthesia: a narrative review of the literature and commentary

MUA or MAM*
Author(s)	Publication year	No. of procedure doses	Study design	Level of research evidence ^†
Kohlbeck FJ, et al. [13]	2005	1 to 3 (over consecutive weeks)	Cohort study (prospective)	II
Palmieri and Smoyak [15]	2002	1 to 4 (over the same number of days)	Cohort study (prospective)	II
Siehl D, et al. [23]	1971	1	Cohort study/RCT ^#	II
Morningstar and Strauchman [21]	2012	3 (over consecutive days)	Case series	IV
Morningstar and Strauchman [19]	2010	3 (over consecutive days)	Case report ⁺	IV
Cremata E, et al. [5]	2005	3 (over consecutive days)	Case series	IV
Herzog J [4]	1999	3 (over consecutive days)	Case report	IV
West DT, et al. [31]	1999	3 (sequentially)	Case series	IV
West DT, et al. [42]	1998	3 (sequentially)	Case series	IV
Davis CG [3]	1996	At least 1 and up to 3 (consecutively or intermittently)	Case series	IV
Alexander GK [22]	1993	5 (serial)	Case report	IV
Davis CG, et al. [12]	1993	3 (over consecutive days)	Case reports	IV
Hughes BL [8]	1993	3 (daily basis)	Case report	IV
Greenman PE [6]	1992	1	Case report	IV
Chrisman OD, et al. [25]	1964	1	Case series	IV
Siehl, D [28]	1963	1 (91%), 2 or more (9%)	Case series	IV
Bremner, RA [29]	1958	1	Case series	IV
Mensor MC [26]	1955	1 (83%), 2 (17%)	Case series	IV
Soden CH [10]	1949	1	Case reports	IV
MUEA/MUESI or MUJA ^ℓ
Dougherty P, et al. [9]	2004	1 (67.5%), 2 (25%), 3 (6.25%), 4 (1.25%)	Case series	IV
Nelson L, et al. [14]	1997	1	Case series	IV
Aspegren DD, et al. [16]	1997	1	Case reports	IV
Dreyfuss P, et al. [18]	1995	1 or 2	Case reports	IV
Ben-David and Raboy [11]	1994	1	Case reports	IV
Warr AC, et al. [30]	1972	1	Case series	IV
Haldeman and Soto-Hall [1]	1938	1	Case series	IV

* With procedural application to one or more spinal regions via general anesthesia or conscious sedation.
^† When applying the levels of evidence rating system for categorizing study quality, as put forth by Wright, et al. [41] and adopted by the Journal of Bone & Joint Surgery[41], Spine, Clinical Orthopaedics and Related Research, the North American Spine Society, the American Academy of Orthopaedic Surgeons, and the Pediatric Orthopaedic Society of North America [43].
⁺ The case report study design has not been rated by Wright, et al. [41]. In terms of qualitative value it is likely most analogous to expert opinion (Level V evidence). However, in eliminating the appearance of bias toward underestimating its significance it has been coupled here with the case series study design and designated as Level IV evidence.
^# Within the medical literature this study has been classified differently, as a Cohort study [13, 34] and as an RCT [2]. As the final paper from Siehl, et al. [23] does not specifically cite the element of patient randomization, the Cohort study design classification appears to be correct. Nevertheless, the results reported [23] pertain to 47 of 147 patients (less than 80% follow-up). Therefore, even as an RCT, this study would qualify as Level II evidence under the rating system put forth by Wright, et al. [41].
^ℓ With procedural application to specific spinal regions via MUEA/MUESI or MUJA (MAM agents applied locally).
Abbreviation key: MAM- medicine assisted manipulation, MUA- manipulation under anesthesia, MUEA- manipulation under epidural anesthesia, MUESI- manipulation under epidural steroid injection, MUJA- manipulation under joint anesthesia.

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ISSN: 2045-709X

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