Biomechanical and neurophysiological responses to spinal manipulation in patients with lumbar radiculopathy.

OBJECTIVE

The purpose of this study was to quantify in vivo vertebral motions and neurophysiological responses during spinal manipulation.

METHODS

Nine patients undergoing lumbar decompression surgery participated in this study. Spinal manipulative thrusts (SMTs) ( approximately 5 ms; 30 N [Sham], 88 N, 117 N, and 150 N [max]) were administered to lumbar spine facet joints (FJs) and spinous processes (SPs) adjacent to an intraosseous pin with an attached triaxial accelerometer and bipolar electrodes cradled around the S1 spinal nerve roots. Peak baseline amplitude compound action potential (CAP) response and peak-peak amplitude axial (AX), posterior-anterior (PA), and medial-lateral (ML) acceleration time and displacement time responses were computed for each SMT. Within-subject statistical analyses of the effects of contact point and force magnitude on vertebral displacements and CAP responses were performed.

RESULTS

SMTs (>/= 88 N) resulted in significantly greater peak-to-peak ML, PA, and AX vertebral displacements compared with sham thrusts (P <.002). SMTs delivered to the FJs resulted in approximately 3-fold greater ML motions compared with SPs (P <.001). SMTs over the SPs resulted in significantly greater AX displacements compared with SMTs applied to the FJs (P <.05). Seventy-five percent of SMTs resulted in positive CAP responses with a mean latency of 12.0 ms. Collectively, the magnitude of the CAP responses was significantly greater for max setting SMTs compared with sham (P <.01).

CONCLUSIONS

Impulsive SMTs in human subjects were found to stimulate spinal nerve root responses that were temporally related to the onset of vertebral motion. Further work, including examination of the frequency and force duration dependency of SMT, is necessary to elucidate the clinical relevance of enhanced or absent CAP responses in patients.