Manipulation Under Anesthesia

This procedure, manipulation under anesthesia (MUA), is a non-invasive procedure increasingly offered for acute and chronic conditions, including: neck pain, back pain, joint pain, muscle spasm, shortened muscles, fibrous adhesions and long term pain syndromes. It is generally considered safe and is utilized to treat pain arising from the cervical, thoracic and lumbar spine as well as the sacroiliac and pelvic regions.

Manipulation under anesthesia uses a combination of specific short lever manipulations, passive stretches and specific articular and postural kinesthetic maneuvers in order to break up fibrous adhesions and scar tissue around the spine and surrounding tissue.

The manipulation procedures can be offered in any of the following ways:

• Under general anesthesia
• During mild sedation
• Following the injection of anesthetic solutions into specific tissues of the spine.

The treatment is performed in a hospital or surgery center by licensed physicians with specialized training and certification specifically for the procedure. A team approach is required to have a safe and successful outcome.

The team includes the anesthesiologist, the prime physician/surgeon/chiropractor who performs the manipulation, and the first assistant, also a physician/chiropractor certified in manipulation under anesthesia. The procedure is commonly performed in a hospital or surgical center.

The combination of manipulation and anesthesia is not new, as this treatment has been part of the manual medical arena for more than 60 years.Manipulation Under Anesthesia is an established medical procedure with a CPT Code designate of 22505. This is noted in the American Medical Association’s Current Procedural Terminology Publication.

Which patients should be considered for manipulation under anesthesia?

Certain neck, mid back, low back or other spinal conditions respond poorly to conventional care. One proposed theory for this is that, as a result of past or present injury, adhesions and scar tissue have built up around spinal joints and within the surrounding muscles and causes chronic pain.

Patients often undergo various treatments, such as physical therapy, chiropractic care, epidural injections, back surgery, or other treatments that do not address fibrous adhesions. Some patients feel temporarily better with these treatments, but their pain often returns.

In general, patients selected for manipulation under anesthesia are those who have received conservative care for six to eight weeks. If limited or no improvements in symptoms or objective findings have occurred, then manipulation under anesthesia may be an appropriate alternative.

Prior to treatment, protocols of diagnostic testing should document the nature of the diagnosis, support the need for treatment and eliminate questions of psychosocial factors that can influence pain responses. In addition to X-ray, MRI scan or CT scan, a musculoskeletal sonogram or nerve conduction velocity test may be ordered.