Spinal manipulation under anesthesia (MUA), performed by chiropractic clinicians since the 1960s, has been the subject of controversy and debate because of the absence of widely accepted guidelines for its practice.¹ As such, the procedure is not universally covered by health insurance companies, many of which regard it as experimental—except for certain allowable conditions, such as frozen shoulder (adhesive capsulitis), and postsurgical conditions, including arthrofibrosis of specific joints.²

MUA itself has a clear purpose: Eliminate fibrotic adhesions thought to be interfering with activities of daily living.³ Less clear is the validity of the procedure as a mode of care for certain spine conditions. Unlike other treatments for these conditions, MUA does not have the backing of large randomized controlled trials and meta-analyses.¹ Chiropractic clinicians who practice MUA have had to find guidance in anecdotal evidence and clinical case reports demonstrating positive results.^1,3 Guidelines on protocols for patient selection and standardization of MUA procedures and follow-up care have been lacking.¹

Recently, however, Gordon and investigators¹ convened a panel of 16 MUA experts to try to develop evidence-informed, consensus-based recommendations for the practice of chiropractic/manual therapy under anesthesia. Patient selection and treatment protocols were the focus.¹ Using an ordinal rating scale ranging from 1 (highly inappropriate) to 9 (highly appropriate), panelists rated statements about MUA.¹ A high level of consensus (80%) was ultimately reached on recommendations regarding all aspects of MUA—including patient selection; diagnosis and establishing medical necessity; treatment and follow-up procedures; evaluation of treatment response; safety practices; appropriate compensation considerations; and facilities, anesthesia, and nursing standards.¹

Chiropractic clinicians who practice MUA, and those who would like to become certified, can now base their MUA-related decisions on consensus-based parameters, established by Gordon and his team.¹ Questions about performing MUA may someday arise for any of the several hundred chiropractic clinicians in the MDOL universe, and for their nearly 3000 patients with adhesive capsulitis of the shoulder—a condition for which MUA is generally accepted by health insurance companies.

References

1. Gordon R, Cremata E, Hawk C. Guidelines for the practice and performance of manipulation under anesthesia. Chiropr Man Therap. 2014;22(1):7.
2. Stanfill J. Manipulation under anesthesia. Forecast Rep. National Insurance Crime Bureau. https://www.nicb.org. January 10, 2011. Accessed March 11, 2014.
3. DiGiorgi D. Spinal manipulation under anesthesia: a narrative review of the literature and commentary. Chiropr Man Therap. 2013;21(1):14.