Archived Policies - Therapy
Spinal Manipulation under Anesthesia
Spinal manipulation under anesthesia (MUA), in the absence of vertebral fracture or dislocation, is considered experimental or investigational.
In the appendicular skeleton, manipulation of the patient under anesthesia may be performed as a treatment of arthrofibrosis, particularly of the shoulder (i.e. frozen shoulder) or knee. In the spine, MUA may be performed as a closed treatment of vertebral fracture or dislocation. This policy does not address the treatment of vertebral fractures or dislocations. In the absence of vertebral fracture of dislocation, MUA performed either with the patient sedated or under general anesthesia is intended to overcome the conscious patient’s protective reflex mechanism, which may have limited the success of prior attempts of spinal manipulation or adjustment in the conscious patient. In MUA, a low velocity/high amplitude technique may be used in contrast to the high velocity/low amplitude technique that is used in the typical spinal adjustment. A single session of MUA may be offered (followed by a series of outpatient sessions) or a series of up to 5 sessions of MUA may be offered, also followed by outpatient sessions. In some instances the MUA may be accompanied by corticosteroid injections.
As with any treatment of pain, controlled clinical trials are considered particularly important to isolate the contribution of the intervention and to assess the extent of the expected placebo effect. A search of the published medical literature did not identify any controlled clinical trials. Several case series were identified, which included patients with cervical, thoracic and lumbar back pain, treated according to varying protocols. In the largest case series, West and colleagues reported on 177 patients with back pain who had failed prior therapy. The patients were treated with 3 sequential manipulations under intravenous sedation, followed by 4 to 6 weeks of further chiropractic spinal manipulation. At 6-month follow-up, there was a 60% improvement in their Visual Analog Scale (VAS) scores. However, this uncontrolled study cannot isolate the contribution of the manipulation under anesthesia compared to the placebo effect, the effect of continued chiropractic therapy, or the natural history of the condition. Other small case series focused on the use of manipulation in conjunction with corticosteroid injections. Similarly, this literature does not permit scientific interpretation.
Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.
West DT, Mathews RS, Miller MR et al. Effective management of spinal pain in one hundred seventy-seven patients evaluated for manipulation under anesthesia. Journal of Manipulative and Physiological Therapeutics 1999; 22(5):299-308.
Aspegren DD, Wright RE,
Ben-David B, Raboy M. Manipulation under anesthesia combined with epidural steroid injection. Journal of Manipulative and Physiological Therapeutics 1994; 17:605-9.
|Title:||Effective Date:||End Date:|
|Manipulation Under Anesthesia||06-15-2018||07-31-2019|
|Manipulation Under Anesthesia||12-01-2017||06-14-2018|
|Manipulation Under Anesthesia||09-01-2016||11-30-2017|
|Manipulation Under Anesthesia||06-15-2015||08-31-2016|
|Manipulation Under Anesthesia||07-01-2014||06-14-2015|
|Manipulation Under Anesthesia||01-15-2013||06-30-2014|
|Spinal Manipulation under Anesthesia||06-01-2008||01-14-2013|
|Spinal Manipulation under Anesthesia||04-01-2007||05-31-2008|
|Spinal Manipulation under Anesthesia||01-23-2004||03-31-2007|
|Manipulation of Spine Requiring Anesthesia, Any Region||05-01-1996||01-22-2004|