Magnetic Resonance Spectroscopy Displays the Structural and Biochemical Effects of Spinal Manipulative Therapy in Lumbar Discogenic Pain: a case report

Abstract INTRODUCTION : We report utility of magnetic resonance spectroscopy (MRS) in identifying the intervertebral disc (IVD) as a pain generator, describe the contemporary pathophysiology underlying biochemical and structural components of discogenic low back pain (DLBP), and exhibit therapeutic responses to spinal manipulation. CLINICAL FEATURES : A 29-year old man presented with uncomplicated low back pain (LBP). The non-specific presentation and clinical exam findings were consistent with non-specific LBP with the IVD as likely pain generator. INTERVENTION AND OUTCOMES: Conventional magnetic resonance imaging showed findings of IVD degeneration including Modic Type 1 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 12 Cox Flexion Distraction treatments at a chiropractic teaching clinic. Follow-up MRS revealed improved IVD spectral features including decreased biochemical pain markers and increased glycoprotein biosynthesis suggesting improved IVD structural integrity. CONCLUSION : We report the first utilization of MRS to quantify structural integrity and biochemical pain profile of the IVD in a conservatively managed DLBP patient. Findings of this case suggest spinal manipulative therapy in DLBP management may improve the structural integrity of IVDs and alter pain biochemistry.