Manipulation under anesthesia for patients with failed back surgery: retrospective report of 3 cases with 1-year follow-up

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This report describes the treatment of 3 patients with previous spinal fusion surgery who had subsequently regressed to their previous levels of pain and disability.

Clinical Features:

Three patients with chronic intractable pain presented to a private integrative medicine clinic for manipulation under anesthesia (MUA) evaluation. All 3 patients had previously had lumbar spine fusion surgery for intervertebral disk herniation. All surgeries were performed at least 2 years before clinical presentation. Patients had plateaued with other conservative pain management strategies before seeking MUA treatment.

Intervention and Outcomes:

The patients were evaluated for MUA. The patients received a serial MUA over 3 consecutive days by trained chiropractic and osteopathic physicians. Outcome assessments used for each patient included a quadruple numerical pain rating scale and functional rating index. Patients completed a course of post-MUA physiotherapy and rehabilitation lasting 8 weeks immediately after the serial MUA. Clinical improvements were observed in all 3 outcome assessments after the MUA, the post-MUA therapy, and were essentially maintained 1 year after conclusion of treatment.


Three patients with failed back surgery were treated conservatively using MUA by trained chiropractic and osteopathic physicians followed by 8 weeks of post-MUA therapy. Pain and disability outcomes all improved immediately following treatment.

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