Intervertebral Disc Magnetic Resonance Spectroscopy Changes After Spinal Manipulative Therapy for Lumbar Discogenic...

Area of Science:

• Biomedical Engineering
• Orthopedics
• Radiology

Background:

• Discogenic low back pain (DLBP) is a significant health issue, often challenging to diagnose and manage.
• Conventional imaging may not fully capture the biochemical and structural changes within the intervertebral disc (IVD) contributing to DLBP.
• Magnetic resonance spectroscopy (MRS) offers a potential tool for detailed IVD analysis.

Observation:

• A patient with chronic DLBP, unresponsive to prior treatments, presented with clinical signs suggestive of IVD as the pain generator.
• Conventional MRI revealed IVD degeneration with Modic type I changes.
• MRS was employed to assess the biochemical and structural status of the affected IVD.

Findings:

• MRS confirmed altered spectral features indicative of DLBP.
• Following 16 sessions of Cox flexion-distraction spinal manipulation therapy (SMT), follow-up MRS demonstrated improved IVD spectral features.
• Specifically, there was a decrease in biochemical pain markers and an increase in glycoprotein biosynthesis, suggesting enhanced IVD health.

Implications:

• MRS can quantify structural integrity and biochemical pain profiles in DLBP patients.
• SMT may offer a viable conservative management strategy for chronic DLBP by positively influencing IVD biochemistry and structure.
• This study highlights the potential of MRS in monitoring treatment efficacy for DLBP.