This study investigates the use of magnetic resonance spectroscopy (MRS) to identify the intervertebral disc (IVD) as a pain generator, explore the pathophysiology of the biochemical and structural components of discogenic low back pain (DLBP), and present potential evidence of physiological responses to spinal manipulation therapy (SMT). A 29-year-old male presented with uncomplicated low back pain (LBP). The non-specific presentation and clinical examination findings were consistent with an initial working diagnosis of non-specific LBP with the clinician suspecting IVD as a likely pain generator. Conventional magnetic resonance imaging showed findings of IVD degeneration including Modic type I changes consistent with a diagnosis of DLBP. MRS was utilized for structural and biochemical analysis of the IVDs. Altered spectral features confirmed a DLBP diagnosis. The patient underwent 16 Cox flexion-distraction SMT treatments at a chiropractic teaching clinic in Chesterfield, Missouri. A follow-up MRS was performed to compare and evaluate post-treatment results. We report the utilization of MRS to quantify the structural integrity and biochemical pain profile of the IVD in a conservatively managed chronic DLBP patient who was unresponsive to previous steroid injections. Comparison between MRS revealed improved IVD spectral features including decreased biochemical pain markers and increased glycoprotein biosynthesis. This implies that the SMT management of chronic DLBP may improve IVD structural integrity and alter pain biochemistry.
Keywords: chiropractic; cox flexion-distraction; low back pain; magnetic resonance spectroscopy; spinal manipulative therapy.
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