Posts for tag: surgery
According to the Mayo Clinic, "back surgery is needed in only a small percentage of cases. Most back problems can be taken care of with nonsurgical treatments, such as anti-inflammatory medication, ice, heat, gentle massage and physical therapy." Accurate on face value, but missing an important piece of the puzzle. Yes, while back pain is rampant, surgery is rarely required; even the Mayo Clinic admits that while "back pain is extremely common ... surgery often fails to relieve it." However, chiropractic is glaringly absent from the nonsurgical recommendations, despite ample research evidence supporting chiropractic care for back pain and increasing reliance on chiropractic as a first-line treatment option.
So, what determines whether a patient undergoes spinal surgery? A recent study attempted to answer that very question and came up with several predictive variables, perhaps the most interesting of which is the type of health care provider – namely a surgeon or a doctor of chiropractic – the back pain patient sees first. The study authors, who note that "there is little evidence spine surgery is associated with improved population outcomes, yet surgery rates have increased dramatically since the 1990s," found that Washington state workers with an occupational back injury who visited a surgeon (orthopedic, neuro or general) first were significantly more likely to receive spine surgery within three years (42.7 percent of workers) than workers whose first visit was to a doctor of chiropractic (only 1.5 percent of workers). This association held true even when controlling for injury severity and other measures.
Of the 174 workers (9.2 percent of the subject population) who had a surgery during the three-year time frame, the vast majority were decompression procedures (78.7 percent), with 3.4 percent undergoing fusion without decompression and 17.8 percent undergoing both on the same day.
Pain coming from compression or irritation of the sciatic nerve is called sciatica. Sciatica – which can include pain, tingling, numbness and muscle weakness – is really a symptom indicating an underlying problem, not a diagnosis in and of itself. This article will explore in detail the findings of a recent controlled study comparing spinal manipulation (chiropractic) and surgery for people whose sciatica did not respond to traditional medical treatment approaches.
The study discussed here was conducted by the National Spine Center in Alberta Canada and published in October of 2010 in the Journal of Manipulative and Physiological Therapeutics. The 40 study participants all had sciatica lasting over 3 months which had not responded to treatment with pain medications, lifestyle modifications, physical therapy, massage therapy or acupuncture. They had all been referred by their primary care physicians to spinal surgeons who had deemed them appropriate surgery candidates.
Instead of having all the patient proceed with surgery, they were split into two groups – one group to undergo a surgical microdiscectomy and the other group to be treated with standardized chiropractic spinal manipulation by a single chiropractor. (If not satisfied with the results they obtained from their assigned method, the patients were allowed to switch to the other treatment plan after 3 months.)
So what happened? Both groups made significant improvements over baseline scores – meaning that they saw noticeable improvements whereas previous approaches had failed. A full 60% of the study participants benefitted from chiropractic spinal manipulation to the SAME degree as if they underwent surgery. And, after 1 year there was no difference in outcome success based on the treatment method. That means that a full 60% of people referred for surgery by their primary care physicians and accepted as surgical candidates by the neurosurgeon could actually get similar results with chiropractic. That is a lot of potentially unnecessary cutting, anesthesia and ER time.
There is one paragraph in the results section of this study that is easy to overlook, but incredibly important. There were originally 120 candidates of which 60 met the study criteria and were asked to participate. Of these 60, 20 refused. Why? Because they had never been offered spinal manipulation as an alternative to surgery! They didn’t want to participate in the study and be randomly placed in the surgery group without first trying the spinal manipulation! This is incredibly telling. Not only does it demonstrate that there is still a lot of education about chiropractic that needs to happen among the public and among primary care providers, it also demonstrates that people understand the risks and costs of surgery and want to exhaust other possibilities first.
This was the first study to ever look at people who had failed traditional medical management of sciatica. Currently most patients that fail ‘conservative care’ are referred for a surgical evaluation. Now we know that 60% of these folks could avoid surgery and get similar long-term outcomes with chiropractic.
Please share this article with anyone considering surgery for sciatica.
McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ., Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. 2010; Oct;33(8):576-84.