Stephen Levit, M.D. on Spinal Manipulation Under Anesthesia: Is the Whole Greater Than the Sum of its Parts?

Stephen Levit, M.D. on Spinal Manipulation Under Anesthesia: Is the Whole Greater Than the Sum of its Parts?

“Spinal manipulation under anesthesia is a controversial procedure for allegedly treating spine pain using osteopathic or chiropractic manipulation techniques while the patient is under general anesthesia or conscious sedation,” explains Stephen Levit, M.D. “Its goal is the relief of spinal pain that, due to muscle spasm and protective guarding, limits the success of traditional manual manipulative therapies.”

“However, implicit in that assumed goal are the very reasons the treatment is controversial. For although belief in the validity of manual and manipulative therapies is unquestioned by chiropractic physicians and some osteopathic physicians, the lack of evidence-based scientific studies in terms of either short or long term outcome proving valid pain reduction is sufficient to result in rejection of the technique's effectiveness for most allopathic osteopaths and medical doctors,” states the author, who is Regional Medical Director for Liberty Mutual Insurance Group. “Even its current proponents admit that the published literature is primarily empiric summaries related in anecdotal fashion by a small subset of clinicians.”

“Thus, over time from its heyday as a recognized procedure for relief of pain in the 1930's and 40's to its minimal utilization as a recognized and accepted treatment procedure today, it has progressively fallen out of favor and been supplanted in the minds of most physicians by other interventional techniques, especially surgery. Nonetheless, it still has its proponents who recommend its use for a variety of diagnoses.” The author then discusses the history, rationale, technique, proposed indications, contraindications, complications, and Medical-Legal status of this procedure.

© Copyright 2010 LexisNexis. All rights reserved. This article was written by Stephen Levit, M.D. Dr. Levit is the Regional Medical Director for Liberty Mutual Insurance Group. He is a graduate of Rutgers College, where he was a Henry Rutgers scholar, and obtained his M.D. at the University of California, San Francisco. Dr. Levit is a member of ACOEM, the International Association for the Study of Pain and the American Academy of Pain Medicine. He is a frequent presenter at CME conferences on the topic of medical practice in the field of Workers Compensation.

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