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Manipulation Under Anesthesia: Pathomechanics

This chapter will develop an overview for a spinal manipulative model that identifies the manipulative lesion for which MUA is most effective – the treatment of pathomechanics of the spine. This discussion conveys the role of the various factors comprising this model which include the three joint complex (intervertebral disc and two posterior motor units), resting length of musculature, articular neurology, the pressure hierarchy of the intervertebral foramen and the role of synovial production and cavitation.

These factors play an important role in moderating the source of back pain by restoring, improving and maintaining mechanical integrity. It has been well documented in the medical literature that chronic unresolved musculoskeletal conditions respond well to manipulation under anesthesia. MUA is a procedure designed to restore the lost range of motion, flexibility and visco-elasticity of the spine and extremities and to reduce scar tissue in soft tissues, peri and intra articular structures which results in articular dyskinesia.

The restoration of motion and the reduction of scar tissue results in more flexibility and visco-elasticity of the paraspinal musculature and associated articulations thereby increasing the functional capacity of the patient. MUA is a procedure utilized in a selected patient population which has been recalcitrant to an adequate trial of conservative care in the office setting. MUA requires the use of non-paralyzing anesthesia (patients continue to breath on their own during the procedure) towards an effort to provide relaxed skeletal musculature enabling the manipulator to reduce fibroblastic proliferative tissue and restore articular motion without patient guarding and pain. Generally, pre-op medications include Versed and Fentanyl with Propofol used in the Operating Room without intubation to accomplish flaccid muscular relaxation. read more»

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