Spinal Manipulation For Patients With Herniated Lumbar Discs…

If “expert” opinion is sought regarding the use of spinal manipulation in patients with herniated lumbar discs, this opinion often ranges from that of being contraindicated, to no indication because of the lack of evidence. While chiropractic experts have often been supportive of the use of this treatment in these patients, they have not carried as much weight with third parties such as insurers. Although spinal manipulation received a boost from the Federal guidelines confirming its efficacy for acute low back pain, even those often cited guidelines suggest that there is no evidence for the use of this treatment in patients with radiculopathy disc herniation.   A few randomized clinical trials examining the use of spinal manipulation for patients with radiculopathy have been reported and suggested favorable outcomes compared to other treatments. Bronfort and Haldeman1 recently summarized these trials concluding:   Three randomized trials examining spinal manipulation for radiculopathy all found it to be superior to the comparative treatment. Several prospective case series have suggested spinal manipulation to be effective in patients with radiculopathy. The quality of these studies has been poor leading to dismissal of the results by most non-chiropractic experts. Not a single serious complication has been reported in these trials that have involved over 2600 patients. ““Current research, however, suggests that it (spinal manipulation for radiculopathy) is of benefit and worthy of inclusion into a comprehensive spine management program””. A more recent randomized controlled trial examining the use of spinal manipulation in patients with lumbar disc herniation with radiculopathy has helped clarify this issue.Burtonet al2 randomized 40 patients to receive either spinal manipulation or chemonucleolysis. Chemonucleolysis was chosen as the comparative treatment because it has already been compared to a placebo in several trials that have confirmed its efficacy.   Patients receiving spinal manipulation had superior outcomes on almost all scales at the majority of outcomes intervals. Spinal manipulation produced significantly greater improvements in back pain levels after 2 and 6 weeks. Chemonucleolysis resulted in no significant back pain improvement in the first 6 weeks.  The 20 patients receiving manipulation had a group total of 165 treatments (mean of 11 per patient) compared to the single session for the chemonucleolysis group. However, the treatment costs for the manipulation group were only 27% of that for the chemonucleolysis, or conversely, the chemonucleolysis was approximately 300% more costly. This is a reoccurring phenomena regarding spinal manipulation; it requires more visits than several other treatments, but the overall treatment process is less expensive and longer lasting.


One Response

  1. SMT is the most cost effective treatment out there for muskuloskeletal symptoms

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