Manipulation Under Anesthesia (MUA)

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Spinal manipulation under anesthesia is a procedure that primarily originated with the osteopathic profession and has been utilized for the treatment of spinal pain since the late 1930s. Documentation regarding the success and value of manipulation under anesthesia has been recorded in the osteopathic literature since 1948 when Clybourne reported in the Journal of American Osteopathic Assoc. a success rate of 80-90% which has been maintained to this day. In the last two decades, the emphasis regarding manipulation in osteopathic education has greatly decreased. Therefore, the osteopaths that had been adequately trained in manipulation are coming to the close of their careers or have retired. Because of the need for continuance of this procedure, the focus for the performance of spinal manipulation under anesthesia has now shifted to chiropractic and their expertise in spinal manipulative skills.

Indications for MUA
Spinal manipulation under anesthesia is a procedure that is intended for patients that suffer from sometimes acute, but mostly chronic musculoskeletal disorders in conjunction with biomechanical aberrancies. These individuals have also been unresponsive to previous conservative therapy. Etiology of their pain can be disc bulge/herniation, chronic sprain/strain, failed back surgery, myofascial pain syndromes in conjunction with those listed below. The procedure is extremely beneficial for the patient that has muscle spasm accompanied with pain and terminal joint range of motion loss. These types of patients typically respond well to manipulation/physical therapy/exercise, but their relief may only be temporary (days to weeks). To ensure good results with a procedure of this type, one of the most important considerations is patient selection.

MUA Procedure and Follow Up Care
MUA is performed using so called moderate sedation usually using propofol and midazolam as the anesthetic drugs. The patient is taken through passive rages of motion, and specific spinal manipulation is performed, followed by passive stretching attempting to restore proper kinetic motion. The patient is then awakened from the anesthesia, which usually occurs minutes after stopping the propofol infusion. The patient is taken to the recovery room and monitored until full recovery has occurred. At that point, post MUA therapy is begun. Post MUA therapy is a vital part of the MUA procedure. It consists of warming up the involved areas, passive stretching, followed by interferential stimulation and cryotherapy. The patient is then discharged home to rest (and cannot drive him-/herself after the procedure).This exact [procedure is repeated serially in most cases by having the patient return to the facility the next day and the following days(s). The average number of days required to accomplish the desired outcome has been shown to be between 2-4 days.

Strict adherence to standards and protocols should be the rule of thumb when considering the MUA procedure and only certified MUA practitioners taught through accredited institutions should be allowed to practice this technique.