Spinal surgery
Manipulation or Micro-diskectomy for Sciatica?

A 2010 study published in JMPT compared the effectiveness of spinal adjusting to micro-surgery for 40 patients with herniated discs and leg pain (sciatica) and at least three months of failure to respond to non-surgical management. Chiropractic treatment took place over a two-month period. Following-up one year later, significant improvement was found in both treatment groups, with no difference in outcome (measured by pain questionnaires) based on which treatment was received. The 8 patients who didn't respond to chiropractic care were able to go on to surgery and have excellent results.

Bottom line: Anyone with a herniated disc that is not responding to medical management should consider chiropractic care.

This new study is very exciting because it provides good evidence that traditional side-posture adjusting is effective for 60% of patients in the study with an MRI-documented symptomatic herniated lumbar disk who have failed to improve with traditional conservative medical care and physical therapy. The benefits of adjusting for the 60% who responded to it were just as good as for those who had the microdisckectomy.

In addition, the discussion section of the study notes that there were no ill effects or complications for those who tried chiropractic care first but failed to respond, later going on to have the surgery. Their surgical outcome was just as good as that of the patients who received surgery initially.

The one limitation of the study is the small sample size of the study, with only 20 patients in each of the treatment groups. But it is encouraging that the 3 neurosurgeons who operated in the surgical portion of the study were all authors and clearly agreed with and co-wrote the conclusion that patients with symptomatic lumbar disc herniation failing medical management should consider a trial of spinal manipulation (followed by surgery if warranted).

Click here to read the abstract.

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Surgical vs Non-operative Treatment for Lumbar Disk Herniation

As many as a million Americans suffer from sciatica. The condition is characterized by an often agonizing pain in the buttocks or leg or weakness in a leg.

This pain is sometimes caused when a ruptured disk impinges on the root of the sciatic nerve, which runs down the back of the leg. And an estimated 300,000 Americans a year have surgery to relieve the symptoms.

Patients are often told that if they delay surgery they may risk permanent nerve damage, perhaps a weakened leg or even losing bowel or bladder control. But nothing like that occurred in this two-year study comparing surgery with waiting in nearly 2,000 patients.

People with ruptured disks in their lower backs usually recover whether or not they have surgery, researchers are reporting today. The study, published in JAMA, conducted a large trial and found that surgery appeared to relieve pain more quickly but that most people with sciatica recovered eventually and that there was no harm in waiting.

Patients who had surgery often reported immediate relief. But by three to six months, patients in both groups reported marked improvement.

After two years, about 70 percent of the patients in the two groups said they had a “major improvement” in their symptoms. No one who waited had serious consequences, and no one who had surgery had a disastrous result. With the new results, it is clear that the risk of waiting is, if not extraordinarily small, at least off the radar screen.

The researchers are also conducting a separate analysis on the cost effectiveness of surgery compared with waiting. Although that analysis has not been published, Dr. Anna N. A. Tosteson of Dartmouth, an author of the study, said that Medicare paid a total of $5,425 for the operation and that private insurers might pay three to four times that.



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