High-Velocity Low-Amplitude Spinal Manipulation for Symptomatic Lumbar Disk Disease: A Systematic Review of the Literature
Bibliographic record
Abstract
OBJECTIVE: The aim of the study was to review the evidence for high-velocity low-amplitude spinal manipulation (HVLASM) for symptomatic lumbar disk disease (SLDD). METHODS: A systematic review of the literature was performed. The Cochrane Central Register of Controlled Trials, Medline, Cumulative Index to Nursing and Allied Health Literature, and Mantis were searched. Evidence-based operational definitions of SLDD, HVLASM, and outcomes measures were established. Articles were assessed using these inclusion criteria: (1) published in English, (2) measured at least one outcome in subjects with SLDD undergoing HVLASM, (3) descriptions were sufficiently clear to meet all 3 categories of our operational definitions. Articles that met the inclusion criteria were assessed by 2 independent reviewers and assigned quality ratings based on previously published guidelines. RESULTS: Sixteen studies met the inclusion criteria, representing 203 total subjects. Of these, 172 subjects received HVLASM as active treatment, and 31 received other treatments as comparison subjects. Improvements in patient-based and physiological outcomes were reported among subjects receiving HVLASM; however, no conclusions regarding safety and effectiveness could be drawn from this review because the overall body of evidence uncovered was lacking in quality and quantity. CONCLUSION: HVLASM for SLDD has been reasonably described in the literature; however, the evidence is limited, and definitive conclusions on safety and effectiveness cannot be made at this time. The reviewed evidence supports the hypothesis that HVLASM may be effective in the treatment of SLDD and does not support the hypothesis that HVLASM is inherently unsafe in SLDD cases. It appears that patients with lumbar disk pathology do undergo manipulative treatment in practice. Consequently, this should be an area of research importance. More high-quality clinical trials using valid and reliable diagnostic criteria and outcomes measures are needed.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".