Spinal manipulation after multiple fusions in an adult with scoliosis: a case report

ABSTRACT

Background: Spinal fusion (SF)is a common surgical intervention for individuals with idiopathic scoliosis. However, individuals may experience continued pain and disability from suspected mechanical dysfunction.

Case Description: The purpose of this case report was to describe how specific thrust manipulation (TM) was used to treat a patient with scoliosis after multilevel SF. The 25-year-old female patient presented with left-sided pain in the rib, thoracic, and lumbar and sacroiliac joint regions that had been aggravated by trail running. After clearance from her surgeon, physical therapy examination and subsequent diagnosis were consistent with mechanical dysfunction of the ribs, lumbar spine, and sacroiliac joint causing decreased ability to participate in high-level activities, such as running.

Outcomes: The patient was treated for eight visits her 4 months with specific TM, movement analysis, and physiotherapeutic scoliosis-specific exercises. Pain and function were assessed with the Trunk Appearance Perception scale (TAPS), Scoliosis Research Society questionnaire (SRS-22), Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), and spirometry. Pain and function improved during treatment, but outcomes for the ODI and spirometry remained the same.

Discussion: The current case report suggests specific TM to areas outside of the fused spinal segments may be beneficial for decreasing pain and improving functional activities and participation levels. However, more research is needed to verify the efficacy of this treatment in clinical practice.

KEYWORDS:

• Idiopathic scoliosis
• spinal fusion
• physical therapy
• manipulation
• ribs
• lumbar spine

Author contribution

Only the authors listed contributed to the article; there were no additional contributors.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval

Subject gave written informed consent.

Supplemental Material

Supplemental data can be accessed here.

Additional information

Funding

This work was not funded.

Notes on contributors

Christina Cuka

Christina Cuka is an assistant professor at A.T. Still University. She practiced in outpatient orthopedics for over 17 years, after graduating with a Master in Physical Therapy from Regis University in Denver, CO. She received her Doctorate in Physical Therapy through the Ola Grimsby Institute in 2006, prior to earning the designation of certified orthopedic manual therapist (COMPT) through the North American Institute of Manual Therapy (NAIOMT). She completed her Fellowship through NAIOMT and her Doctor of Science in Physical Therapy through Andrews University in Berrien Springs, Michigan. Additionally, she completed three certification in scoliosis specific schools for treating scoliosis: the Schroth method, the Barcelona scoliosis physical therapy school (BSPTS) and the scientific exercise approach to scoliosis (SEAS). She is a board certified orthopedic clinical specialist (OCS) and a member of the American physical therapy association (APTA) and American Academy of orthopedic manual therapy (AAOMPT).

Amy W. McDevitt

Amy McDevitt is an Assistant Professor in the Physical Therapy Program at the University of Colorado School of Medicine. Clinically she practices at the University of Colorado Health, CU Sports Physical Therapy and Rehabilitation. She is a board-certified Orthopaedic Clinical Specialist and a Fellow in the American Academy of Orthopaedic and Manual Physical Therapists. She is currently completing her clinical PhD through the University of Newcastle Australia. Amy is active in clinical and educational research at the University of Colorado and her research interests include shoulder pain, regional interdependence, dry needling and assessment of clinical reasoning.

Ann Porter-Hoke

Ann Porter Hoke received her Diploma in Physiotherapy from St. Thomas’ Hospital, London in 1971, her BScPT from the University of British Columbia in 1982 and a post professional doctorate from Pacific University, Oregon in 2008. She is a Fellow of both the Canadian and American Manual and Manipulation Academies and is a Board Certified Orthopaedic Specialist. She has served on numerous national and international OMPT committees and has been involved in the development of the Description of Advanced Specialist Practice in OMPT and Educational Standards. Her awards include: Mercedes Weiss, from the Oregon PT Association (1996) and the John McM. Mennell Service Award from AAOMPT in 2006. She is a distinguished faculty member, senior examiner, clinical fellowship director and clinical instructor with NAIOMT and has 43 years of teaching and 48 years of clinical experience. She teaches all levels of NAIOMT core and specialty classes in mobilization and manipulation.

Steve Karas

Steve Karas is a faculty member at Chatham University where he teaches orthopedics and spine, a member of the IRB and maintains consistent clinical practice. He is the Research Director for The North American Institute for Orthopedic Manual Therapy and obtained his Doctorate from Andrews University with a manual therapy certification from NAIOMT. His current research includes grant funded study of techniques and outcomes of thoracic spine manual therapy, stability testing of the upper cervical spine, and treatment fidelity in manual therapy research. Some of his publications include orthopedic special test assessment, spine palpation, knowledge translation, and research fidelity. His work includes collaboration with co-authors from seven different countries. He has presented nationally and internationally on these topics. Dr. Karas is a member of the AAOMPT research committee & education special interest group, and a reviewer for several journals. He is currently pursuing a nutrition certification at Cornell University.