[Results of manual therapy in degenerative spine diseases with and without radiculopathy. (Literature review)].

Abstract

The prevalence of degenerative diseases of the spine, including neck and low back pain, which reduce the ability to work and lead to disability, is increasing. We have studied the materials of clinical studies, meta-analyses and systematic reviews devoted to the evaluation of the results of manual therapy in patients with degenerative spine diseases, including those who underwent surgical treatment. The analysis (38 sources were analyzed, including 15 meta-analyses and 21 systematic reviews) revealed the ability of manual therapy to influence the level of acute and chronic pain (local and projection), duration of pain-free period, functional status of patients with degenerative spine diseases, including those with radiculopathy and after surgical treatment. There is medium-quality evidence (9 studies, 1176 patients) of a positive effect of manipulation and mobilization on vertebral pain levels and spinal motor activity in patients with chronic low back pain - manipulative therapy and mobilization compared with exercise or physical therapy statistically significantly reduced pain (SMD=-0.28, 95% CI -0.47 to -0.09, p=0.004; I 2 =57%). It was also observed that the effect was stronger at 3 months after intervention (370 patients SMD=-0.68, 95% CI -1.14 to -0.23; I2= 73.7%) and 6 months of follow-up (3 studies, 223 patients) (SMD=-0.72, 95% CI -0.99 to -0.45; I2= 0%). Medium-quality evidence suggests that myofascial release is more effective in controlling pain than control treatments (LFC, simulated osteopathic manipulative treatment, physiotherapy) (ES: -0.69; 95% CI: -1.05, -0.33; P=0.0002), even at follow-up after 12 weeks (ES: -0.73; 95% CI: -1.09, -0.37; P<0.0001). There is also medium-quality evidence (47 RCTs, 2678 individuals) of the efficacy of manual therapy for cervical and lumbar radiculopathy. In particular, mobilization of the nervous system resulted in a significant reduction in pain intensity (Hedges' g=-1.097, 95% CI=-1.482 to -0.712, p<0.001, I2=85.338%). Thus, the review presented evidence based on meta-analyses and systematic reviews of medium and low quality that manual therapy for degenerative spine diseases relieves acute and chronic pain in the cervical and lumbar spine, reduces musculoskeletal and radicular pain, and is effective in the rehabilitation of patients undergoing surgical treatment for herniated discs.