Can seeing a chiropractor reduce the need for lumbar discectomy?
Lumbar disc herniations (LDH) are relatively common and certainly something you will encounter in practice. These patients require a comprehensive clinical workup, with careful consideration to the best plan of management.
LDH involves a focal displacement of intervertebral disc material beyond the normal limit of the disc margin, which may lead to compression of one or more nerve roots, resulting in lumbosacral radiculopathy (LSR). Clinical features of LSR include radiating lower extremity pain, sensory disturbances in a predictable pattern, weakness, and/or diminished muscle stretch reflexes. Both conditions (LDH or LSR) are common reasons for patients to receive chiropractic care or surgical intervention in the form of a discectomy.
Chiropractors may use various modalities to treat LDH/LSR, but it is common to use chiropractic spinal manipulative therapy (CSMT), which has been shown to be beneficial for treating these conditions. American and international practice guidelines recommend CSMT for low back pain and LSR.
Severe neurologic deficits and/or caudal equine syndrome (CES) are absolute indications for lumbar discectomy, while continued pain despite conservative treatment that affects quality of life is a relative indication. For patients without absolute indications, early discectomy can provide short-term benefits, however, long-term outcomes at 1-2 years are similar to those receiving conservative care.
While prior studies have looked at the association between chiropractic care and lumbar spine surgery, they have looked at broader populations and/or outcomes. This study aimed to examine the association between CSMT for newly diagnosed LDH and/or LSR and the odds of lumbar discectomy over 1-year and 2-year follow-up windows.
RESEARCH REVIEW: “Association Between Chiropractic Spinal Manipulation and Lumbar Discectomy in Adults with Lumbar Disc Herniation and Radiculopathy”
This paper was published in BMJ Open (2022).
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