Australasian chiropractic & osteopathy : journal of the Chiropractic & Osteopathic College of Australasia最新文献

Objective: To discuss a case of leptomenigeal disease mimicking a lower lumbar disc lesion and accompanying neurological deficit.Clinical Features: A 62 year old male presented with a 3-4 day history of left low back and left posterior thigh pain. The patient had a previous history of non-specific low back pain for approximately 10-25 years, which was relieved in the past by manual therapy. He was also currently being treated by a medical oncologist with chemotherapy for low grade non-Hodgkin's lymphoma, which was considered stable.Intervention and Outcome: After a favourable initial response to therapy, the patient developed a noticeable left-sided limp. Computed tomography scanning of the lumbar spine and pelvis was then performed, which revealed a mild posterior annular bulging of the intervertebral disc at the L4/5 level. The patient was then treated with axial lumbar spine traction but on review two days later had also developed a left sided facial droop, consistent with a Bell's palsy. A subsequent magnetic resonance imaging scan of the brain and lumbar spine revealed sites of abnormal enhancement of multiple cranial nerves, the cauda equina and the vertebral bodies L1 and L5. The findings were consistent with widespread leptomeningeal disease or leptomenigeal carcinomatosis and unfortunately the patient died as a direct consequence of the disease approximately three weeks after diagnosis.Conclusion: Although relatively rare, leptomenigeal disease must considered as a differential diagnosis in a patient with a history of carcinoma who presents with low back pain and/or any neurological signs and symptoms.

The pathogenesis, pathology, natural course, and in particular the treatment of lateral epicondylitis (tennis elbow) remains controversial. An extensive review of the scientific literature with respect to the conservative treatment of tennis elbow, revealed that acceptable epidemiological techniques of the prospective randomised control trials or case controlled studies are scarce. While administration of steroid compounds has traditionally been the mainstay of conservative treatment of tennis elbow, the high recurrence rate of side effects and structural tissue changes associated with steroid therapy, leaves this modality as the most controversial approach in the treatment of tennis elbow. In contrast, in some studies evidence in favour of a role for classical acupuncture, ultrasound and low level laser as effective therapeutic means in the treatment of tennis elbow has been provided. As these modalities have not been associated with any side effects, in view of the ease of application, low cost and good curative effects, their increased application has been suggested by some authors. This proposition, however, remains rather conjectural until it could be convincingly substantiated by future studies with appropriate epidemiological design.

Objective: This study examines the effect of chiropractic spinal manipulative therapy on salivary cortisol levels.

Design: Prospective case series over six weeks duration. The trial consisted of establishment of each individual's baseline cortisol level, a two week treatment period (4 treatments), and a two week post treatment period.

Setting: Macquarie University Chiropractic Research Centre.

Participants: Nine subjects (six male, three female), employed in a large corporation, volunteered to the trial of spinal manipulative therapy.

Main outcome measures: Saliva samples were analysed using an Amerlex Radioimmunoassay Kit to determine the cortisol concentrations present.

Results: Statistical interpretation, after exclusion of an apparent outlying subject, revealed results of statistical significance (p<0.001) for reduction of salivary cortisol over the complete five week study. In addition, there was no apparent alteration in salivary cortisol levels immediately preceding and 15 minutes after spinal manipulative therapy.

Conclusion: The initial evidence is inconclusive, however, the potential relationship demands further investigation. Additional research is necessary in measuring the physiological effects of Chiropractic spinal manipulative therapy. This method is currently being used in a larger randomised controlled trial.

Objective: To review the available literature pertaining to the therapeutic benefits of the audible release associated with spinal manipulative therapy. A critical appraisal of the scientific literature, empirical evidence and theories relating to this aspect of manipulation is presented.

Data source: A broad based search of the English language literature was conducted utilising the databases Medline (1966-1998), Mantis (Health Index) (1880-1998) and Cumulative Index to Nursing and Allied Health (CINAHL) (1982-1998), using the key words crack/ing, cavitation, audible release, gapping, sound/s, noise/s, vibration, biomechanics, coupled with joint, articular, manipulation, spinal manipulation and spinal manipulative therapy. A manual search was also conducted of non-indexed journals and text books relating to manual therapy of the library of RMIT University, Bundoora, Victoria as well as a broad based Internet search.

Results: There is a paucity of scientific research relating to this specific aspect of spinal manipulative therapy. Although there is ample empirical evidence to support some therapeutic benefit from the audible release, only one scientific study specifically relating to this topic was uncovered.

Conclusion: Currently there is little scientific evidence to support any therapeutic benefit derived from the audible release and in fact, it appears the available evidence tends to refute many of the alleged beneficial effects. Given that many practitioners and patients alike place an importance on this aspect of manipulation further research is required in order to fully investigate this phenomenon.

The Subclavian Steal Syndrome is a condition that results from the stenosis or occlusion of the subclavian artery proximal to the origin of the vertebral artery. The blockage causes the reversal of the normal direction of blood flow in the vertebral artery which is termed the "steal", because it steals blood from the cerebral circulation. Blood is drawn from the contralateral vertebral, basilar or carotid artery regions into the low-pressure ipsilateral upper limb vessels. Although a relatively uncommon disease, it represents a condition which mimics many conditions often treated by chiropractors and osteopaths. The term subclavian steal syndrome is applied when reversed vertebral artery flow causes cerebral ischaemia with associated symptoms of vertebrobasilar hypoperfusion and/or symptoms of brainstem or arm ischaemia. This syndrome exists as an important consideration in the differential diagnosis of cerebral and brachial ischaemia.

Objective: To evaluate the cost effectiveness of a spinal care lecture (conducted by a chiropractor) in reducing the number of spinal injuries and their associated costs in the workplace.Method: A lecture was designed to increase employees awareness of spinal injury and how it might be prevented. The lecture was designed following a work-place inspection, to assess the most likely risk factors for injury. The lecture also included advice on posture, normal biomechanics and alternative strategies to improve spinal health.Subjects: Volunteer subjects, all from the same company, were randomly assigned to a study group (n = 34) and a control group (n = 27). The remaining employees (n = 60) formed a non intervention (baseline) comparison group.Main Outcome Measures: The number and severity of injuries for all groups was monitored over a six month period prior to and following the lecture. In addition, Oswestry pain and disability questionnaires were collected prior to the lecture and at the six month follow up period.Results: The average cost of injuries went from $451 in the six months prior to training down to $194 in the first three months and then to $269 at six months after training. In comparison, the corresponding control group figures were $396, $409 and $382, respectively.Discussion: The cost of reported back injuries decreased by 57% in the first three months for the educated group when compared to pre-intervention levels. At the six month follow up the cost of back injuries remained 40% lower than previous levels.Conclusion: The results from our study demonstrated a statistically significant reduction (p< .05) in the cost of back injuries and Oswestry pain scores, following an employee training program conducted by a chiropractor.

Objectives: To determine whether a correlation between motion palpation findings and abnormal coupling patterns, as viewed in lumbar functional X-rays, can be demonstrated in low back pain (LBP) patients.Design: A prospective observational study of patients who present to a chiropractic clinic for assessment of low back pain.Subjects: The sample population consisted of 27 consecutive patients presenting with LBP between the ages of 20-50 year old and who were capable of pain free lateral lumbar flexion.Intervention: All subjects underwent motion palpation to determine whether a "fixation" at the L4/5 existed. All had lumbar spine X-rays in an anterior-posterior (AP) and bilateral AP lateral flexion position. X-rays were then analyzed to determine whether the coupling pattern at L4/5 was considered abnormal.Results: In those patients with a perceived L4/5 motion restriction no coupling patterns where found in 6 cases (22.4%) and normal coupling patterns in 13 cases (48%). In those patients who presented with LBP and no motion findings at L4/5 no coupling was observed in 4 cases (14.8%) and normal coupling in another 4 cases (14.8%). The chi-squared test demonstrated no statistical differences (p>0.05) between the motion fixation at L4/5 and coupling patterns from lateral flexion X-rays.Conclusion: It is of particular interest to note that the presence of the L4/5 fixation was not associated with abnormal coupling but conversely was frequently observed to be associated with normal coupling patterns. A simple correlation between a single motion palpation finding of a restriction at a L4/5 facet and an alteration in coupling patterns could not be supported.