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Neuromechanical Characterization of in Vivo Lumbar Spinal Manipulation. Part II. Neurophysiological Response

March 17, 2015

AUGUST 11, 2003

Reference: Christopher Colloca. DC, Tony S. Keller, PhD,  and Robert Gunzburg, MD, PhD; Neuromechanical Characterization of in  Vivo Lumbar Spinal Manipulation. Part II. Neurophysiological Response;  Journal of Manipulative and Physiological Therapeutics 2003; 26(9);  579-91




Objective: To simultaneously quantify vertebral motions  and neuromuscular and spinal nerve root responses to mechanical force,  manually assisted, short-lever spinal manipulative thrusts.


Methods: Four patients underwent lumbar laminarthrectomy  to decompress the central spinal canal and neuroforamina, as clinically  indicated. Prior to decompression, finely threaded, 1.8-mm diameter  intraosseous pins were rigidly fixed to the lumbar spinous process (L1  or L3) using fluoroscopic guidance, and a high-frequency, low-noise,  10-g, triaxial accelerometer was mounted to the pin. Following  decompression, 4 needle electromyographic (nEMG) electrodes were  inserted into the multifidus musculature adjacent to the pin mount  bilaterally, and 2 bipolar platinum electrodes were cradled around the  left and right S1 spinal nerve roots. With the spine exposed, spinal  manipulative thrusts were delivered internally to the lumbosacral  spinous processes and facet joints and externally by contacting the skin  overlying the respective spinal landmarks using 2 force settings (= 30  N, < 5 milliseconds (ms); = 150 N, < 5 ms) and 2 force vectors  (posteroanterior and superior; posteroanterior and inferior).


Results: Spinal manipulative thrusts resulted in  positive electromyographic (EMG) and compound action potential (CAP)  responses that were typically characterized by a single voltage  potential change lasting several milliseconds in duration. However,  multiple EMG and CAP discharges were observed in numerous cases. The  temporal relationship between the initiation of the mechanical thrust  and the neurophysiologic response to internal and external spinal  manipulative therapy (SMT) thrusts ranged from 2.4 to 18.1 ms and 2.4 to  28.6 ms for EMG and CAP responses, respectively. Neurophysiologic  responses varied substantially between patients.


Conclusions: Vertebral motions and resulting spinal  nerve root and neuromuscular reflex responses appear to be temporally  related to the applied force during SMT. These findings suggest that  intersegmental motions produced by spinal manipulation may play a  prominent role in eliciting physiologic responses. (J Manipulative  Physiol Ther 2003; 26:579-91)

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