For most cases of lumbar disc herniation and lumbosacral radiculopathy
Editorial Staff
The authors of a new study1 hypothesized that adult patients with newly diagnosed lumbar disc herniation or lumbosacral radiculopathy who received chiropractic spinal manipulative therapy would be less likely to ultimately undergo lumbar discectomy compared to similarly diagnosed adults receiving non-chiropractic care.
Published in BMJ Open, the study population, drawn from a 101-million-patient U.S. health records network, included adults ages 18-49 with lumbar disc herniation or lumbosacral radiculopathy. Exclusionary diagnoses included prior lumbar surgery, absolute indications for surgery, trauma, spondylolisthesis and scoliosis.
Ultimately, more than 11,000 patient records were analyzed, yielding two equivalently sized study cohorts (5,785 apiece) based on whether patients had received chiropractic spinal manipulative therapy (CPT codes 98940, 98941 or 98942) vs. other care.
Patients receiving CSMT were significantly less likely to undergo discectomy at both one- and two-year follow-up compared with patients receiving other care. Potential confounding variables associated with an increased likelihood of lumbar surgery, such as older age, gender (male), obesity, history of lumbar injections, prior treatment with opioids or prescription pain medication, etc., were accounted for by the study authors.
"Considering the current study excluded absolute indications for surgery and serious pathology, we suggest our findings may be explained by pain relief afforded by CSMT. Previous studies have shown that LDH/LSR have good prognosis with at least half of patients experiencing significant relief in the first 3-12 months. As most patients will undergo surgery within 2-12 months of symptom onset, we suggest initial pain relief afforded by CSMT could allow patients to avoid surgery during this early critical period."
Reference
Trager RJ, et al. Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States' data. BMJ Open, 2022;12(12):e068262. Click here for free full text.
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