Hello and welcome to this week’s edition of HealthBeat, Chiropractic OnLine Today’s Health, News and Informational Podcast.
In this week’s news: We’ll Be Looking At –
- Risk–Benefit strategy to Exclude Cervical Artery Dissection in SMT
- And Finally, a Story about Lumbar Discectomy and Lumbar Fusion Rates
For HealthBeat …. This is Dr. Todd Eglow!
Welcome to HealthBeat Podcast #684 recorded August 30, 2019
HealthBeat is Chiropractic OnLine Today’s radio program, providing current news and commentary about Chiropractic and Health.
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Risk–Benefit strategy to Exclude Cervical Artery Dissection in SMT
Cervical artery dissection refers to a tear in the internal carotid or the vertebral artery that results in an intramural haematoma and/or an aneurysmal dilatation.
Although cervical artery dissection is thought to occur spontaneously, physical trauma to the neck, especially hyperextension and rotation, has been reported as a trigger. Headache and/or neck pain is the most common initial symptom of cervical artery dissection.
Other symptoms include Horner’s syndrome and lower cranial nerve palsy. Both headache and/or neck pain are common symptoms and leading causes of disability, while cervical artery dissection is rare.
Patients often consult their general practitioner for headache and/or neck pain, and because manual-therapy interventions can alleviate headache and/or neck pain, many patients seek manual therapists, such as chiropractors and physiotherapists.
Cervical mobilization and manipulation are two interventions that manual therapists use. Both interventions have been suspected of being able to trigger cervical artery dissection as an adverse event.
The aim of this review, published in the journal the Annals of Medicine, is to provide an updated step-by-step risk–benefit assessment strategy regarding manual therapy and to provide tools for clinicians to exclude cervical artery dissection.
Surf to our Show Notes for the full review – https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627
Lumbar Discectomy and Lumbar Fusion Rates
The 2019 study published in the journal Spine, aimed to calculate a more definitive rate of lumbar fusion after a lumbar discectomy procedure using a population-size study of more than 200,000 patients who underwent discectomies.
Additionally, the study aimed to compare the rate of lumbar fusion in patients who have undergone a lumbar discectomy to the rate of lumbar fusion in patients with no prior lumbar discectomy procedure.
Lumbar disc herniation affects more than 3 million people in the United States every year, and the rate of operation continually increases, particularly in patients 60 years or older. Surgical discectomy is a common treatment for lumbar disc herniation.
In the conclusions for this study, the authors stated that their study is the largest population study that explores the rate of lumbar fusion after an initial lumbar discectomy. To the author’s knowledge, it is the first study that concludes that an initial lumbar discectomy is statistically associated with an increased likelihood of a patient undergoing a lumbar fusion in the future.
The authors observed that patients who had previously undergone a lumbar discectomy were roughly three times more likely to undergo a lumbar fusion procedure than a patient with a lumbar diagnosis, but had not undergone a lumbar discectomy. Although not calculated, it stands to reason the difference would be even greater when comparing the discectomy population with a population without lumbar diagnoses.
This finding can be an important supplement for the physician-patient discussion regarding expectations and potential for reoperation.
Surf to our Show Notes for Links – https://www.ncbi.nlm.nih.gov/pubmed/29792995
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For Chiropractic OnLine Today’s HealthBeat, This has been
Dr. Todd Eglow.