J Manipulative Physiol Ther. 1994 Nov-Dec; 17(9): 605-9.

Manipulation under anesthesia combined with epidural steroid injection.

Ben-David B, Raboy M.

Herzliya-Haifa (Horev) Medical Center, Israel.

OBJECTIVE: To demonstrate the benefit of cooperation between medical and chiropractic specialists and the usefulness of combining chiropractic and epidural injection in particular cases of back pain. CLINICAL FEATURES: Two cases of low back pain, both with disk protrusions and osteophytic changes, had no response to several weeks of alternate day (or more) chiropractic care. A third case of herniated intervertebral disks and low back pain had no improvement from treatment with epidural steroidal injection. INTERVENTION AND OUTCOME: The two cases of failed response to chiropractic each experienced a dramatic therapeutic leap with a single treatment of manipulation under anesthesia/epidural steroid injection (MUA/ESI). Both patients maintained their improved condition on tapering schedules of maintenance chiropractic care. In the third case of failed response to ESI, severe pain precluded initial chiropractic treatment. This was only possible at the first treatment with MUA provided by epidural injection. A single treatment of MUA/ESI brought rapid and profound relief and was followed by continued chiropractic care. The patient remained pain-free except for a brief partial relapse that responded promptly to chiropractic. CONCLUSIONS: Cooperation between medical and chiropractic specialists is to be encouraged. These cases demonstrate cooperation between an anesthesiologist and a chiropractor. By using a single treatment of manipulation under epidural anesthesia/epidural steroid followed by continued chiropractic, we were able to lead our patients out of therapeutic dead ends and deal with the dilemma of a patient in too much pain to tolerate an initial chiropractic treatment.