Intervertebral Disc Magnetic Resonance Spectroscopy Changes After Spinal Manipulative Therapy for Lumbar Discogenic Pain

Why This Matters

Discogenic low back pain is often difficult to diagnose and manage, with imaging findings not always correlating with symptoms. This study explores whether advanced imaging—magnetic resonance spectroscopy (MRS)—can both identify the disc as a pain generator and detect physiologic changes following spinal manipulative therapy. This raises an important question: can conservative care influence not just symptoms, but disc biology itself?

What the Research Found

This case study followed a 29-year-old patient with chronic discogenic low back pain who had not improved with prior steroid injections. Conventional MRI showed disc degeneration with Modic type I changes. Magnetic resonance spectroscopy (MRS) was used to assess biochemical and structural properties of the disc before and after treatment.

The patient underwent 16 Cox flexion-distraction treatments. Follow-up MRS demonstrated measurable changes in disc biochemistry and structure.

Key Findings:

    • MRS identified biochemical markers consistent with discogenic pain
    • Post-treatment imaging showed decreased biochemical pain markers
    • Increased glycoprotein biosynthesis, suggesting improved disc matrix activity
    • Findings suggest changes in both disc structure and biochemical environment
    • Improvements occurred after a course of spinal manipulative therapy following failed injections

Clinical Takeaways

    • Recognize that discogenic pain may involve biochemical changes not visible on standard MRI
    • Be aware that advanced imaging such as MRS may help identify the disc as a pain generator
    • Consider that spinal manipulation may influence disc physiology—not just symptom relief
    • Interpret results cautiously, as this is a single case study and not generalizable
    • Use this as hypothesis-generating evidence supporting further research into biologic effects of conservative care

Where Collaborative Spine Care May Support This

Chiropractors—who perform the majority of spinal manipulation in the United States—along with other manual medicine providers, may play a role in managing discogenic low back pain. This study specifically evaluated Cox flexion-distraction, a well-established technique within chiropractic that uses low-velocity, low-amplitude, segment-specific spinal distraction rather than high-velocity thrust manipulation.
These findings suggest that certain forms of spinal manipulation may influence disc physiology and pain biochemistry. However, it remains unclear whether similar effects occur with other techniques, and broader conclusions cannot be drawn from a single case. While flexion-distraction is widely utilized in practice, only a small percentage of chiropractors have completed formal certification in Cox flexion-distraction, which involves specific protocols and technique application that may be relevant to outcomes observed in this study.

Reference

Billham JF, Shi D, Roland EE, Gornet MF, Brinkman KK, Schranck FW, Cox JM, Kettner NW. Intervertebral Disc Magnetic Resonance Spectroscopy Changes After Spinal Manipulative Therapy for Lumbar Discogenic Pain.