A groundbreaking study reveals spinal manipulative therapy as a potential game-changer in reducing lumbar discectomy reoperations, signaling a paradigm shift in spinal healthcare and offering renewed hope to millions

Each year, countless individuals undergo lumbar discectomy to alleviate the excruciating pain associated with lumbosacral radiculopathy. Despite the surgical intervention, a significant percentage of patients face the prospect of reoperation, highlighting the complexity of treating back pain effectively. A groundbreaking study from University Hospitals Cleveland Medical Center, led by Trager et al., sheds new light on this issue. The research, which delves into the potential of spinal manipulative therapy (SMT) -- a foundational modality of chiropractic care -- in reducing the need for subsequent surgeries, offers a beacon of hope for patients and healthcare practitioners alike. This study is particularly relevant given the increasing inclination towards non-invasive treatments in modern medical practice.¹

Study Overview

The study, "Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study," published in BMC Musculoskeletal Disorders, embarked on an explorative journey into the aftermath of lumbar discectomy surgeries. Focusing on patients with ongoing lumbosacral radiculopathy post-surgery, the research utilized a retrospective cohort design, analyzing data sourced from TriNetX Inc., a U.S. health records consortium. This dataset spanned two decades, providing a comprehensive overview of patient demographics and health outcomes.²

Key Findings

The study's results are pivotal in understanding the role of spinal manipulative therapy (SMT) in post-lumbar discectomy care. The research found a significant reduction in the rate of reoperations for patients who received SMT. Specifically, the incidence of lumbar spine reoperation over two years was 7% in the SMT cohort, compared to 13% in the usual care group. This translates to a risk ratio (RR) of 0.55 (95% CI, 0.35–0.85; P = 0.0062), indicating a 45% reduction in the likelihood of undergoing another surgery for those who received SMT.³

Implications of the Study

The implications of this study are far-reaching, both for clinical practice and the broader healthcare context. It suggests that incorporating SMT into post-discectomy care plans could significantly reduce the need for additional surgeries. This finding is particularly relevant in light of the high costs and physical and emotional burden associated with repeat spinal surgeries.⁴

Limitations and Future Research

Despite the promising findings, the authors of the study cautioned about the limitations inherent in observational studies like theirs. They highlighted the potential influence of unmeasured confounding variables and the inability to establish causality. The study's retrospective nature and reliance on existing health records data also meant that detailed patient-level data, particularly concerning the exact timing and nature of the discectomies and the specifics of the SMT interventions, were not available.⁵

Conclusion

This study marks a significant step forward in understanding the potential role of spinal manipulative therapy in reducing the need for lumbar spine reoperation following discectomy. Its findings suggest that SMT could be a valuable addition to postoperative care, offering a non-invasive, cost-effective treatment alternative that may lead to better patient outcomes and reduced healthcare costs.⁶

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References

1 Robert J. Trager et al., "Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study," BMC Musculoskeletal Disorders 25, no. 1 (2024).

2 Ibid.

3 Ibid.

4 Ibid.

5 Ibid.

6 Ibid.