Before undergoing spinal MUA, it is important to weigh the procedure’s potential risks with its expected benefits. These risks and benefits can vary widely depending on each individual case.

When to Avoid Spinal MUA

When considering spinal MUA, the patient is screened for any conditions that would make the body unlikely to safely handle the procedure’s extensive stretching, high-velocity maneuvers, and/or medications. Some specific contraindications for spinal MUA include:

  • Bone fracture in area to be manipulated, such as spine, pelvis, arm, or leg
  • Spinal infection
  • Cancer
  • Spinal cord compression with long-tract signs
  • Cauda equina syndrome
  • Spinal osteoporosis or other bone weakness
  • Obesity
  • Neurological disorders (including uncontrolled diabetes)
  • Acute gout attack
  • Advanced age

Many other conditions could also make it preferable to delay or avoid spinal MUA, such as pregnancy or inability to have anesthesia.

See Management of Back Pain in Pregnancy

When Spinal MUA May Be Considered

Spinal manipulation under anesthesia may be considered as an alternative form of treatment for patients with one or more of the following symptoms after non-surgical (conservative) care has proven ineffective:

  • Neck, mid back, and/or lower back pain
  • Chronic muscle pain and inflammation
  • Chronic muscle spasm (or acute spasm that has returned)
  • Decreased spinal range of motion
  • Pain radiating into an arm or leg (nerve entrapment)
  • Cervicogenic headache (pain from the cervical spine that goes up into the head)

See Chronic Pain As a Disease: Why Does It Still Hurt?

In general, spinal MUA is commonly considered in situations where traditional manipulation is expected to be safe and beneficial but cannot be performed due to high levels of pain and/or reduced range of motion.

See Understanding Spinal Manipulation


Spinal MUA to Help Avoid Other Treatments

In some cases, spinal MUA is worth trying because other treatments for chronic spinal pain have either stopped working or are too risky for the patient. A couple of examples include:

  • Prescription pain medications. Even severe cases of neck or back pain can typically be managed by prescription pain medications, such as opioids. Over time, however, opioids may become less effective and require higher doses, which can pose risks for addiction and other major health concerns. Prescription-strength muscle relaxers also have similar risks when used long-term. Prescription pain medications are typically only recommended for short-term use.

    See Opioid Pain Medications

  • Surgery. Even in cases where imaging identifies a spinal pain source that can likely be corrected with surgery, the procedure and its relatively strenuous recovery period may be too risky or unappealing for some patients.

    See Back Surgery and Neck Surgery Overview

In cases such as these, spinal MUA may offer some relief for chronic pain with fewer risks.


Patient Safety for Spinal MUA

To minimize the risks associated with spinal MUA, the following two conditions must be met:

  • Thorough patient evaluation. A medical history is taken and physical exam is given. Medical imaging and lab tests are also likely to be given, such as x-rays and/or an MRI to check spinal stability, and blood tests to rule out diseases or infections.

    See Introduction to Diagnostic Studies for Back and Neck Pain

  • Medical team certified in spinal MUA. Manipulation under anesthesia requires special training by the doctors who administer it. Compared to traditional manual manipulation, MUA has some additional risk factors, including the usage of anesthesia, as well as the extra care needed to ensure that the sedated patient does not fall off the table or become injured in other ways. Also, anesthesia is administered by either an anesthesiologist or certified registered nurse anesthetist (CRNA).

Spinal MUA is not advised if these conditions are not met.

Dr. Angela Christopher is a chiropractor specializing in spine care and sports medicine. For more than 10 years she owned AZ Spine Disc and Sport, a multi-specialty sports medicine and pain management practice in Phoenix, AZ.