Disc herniations - Spinal manipulation vs surgery - a research update

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I thought that I would share the results of a very interesting study that was recently published. The results challenge the commonly held notion that the solution for lumbar disc herniations (and related sciatica) is surgery.

The study, entitled “Manipulation or Microdiskectomy for Sciatica? A Prospective Randomized Clinical Study” (JMPT, Dr. McMorland, D.C., Dr. Casha MD, PhD, FRCSC, Dr. du Plessis MD, Dr. Hubert, MD, PhD, FRCAC, FACS, 2010) looked at patients who were suffering from sciatic nerve related pain secondary to a lumbar disc herniation, and who were not responding to medical management for at least 3 months.

In this year-long study, patients were randomly chosen to receive approximately 20 chiropractic treatments over the course of the year, or surgery (the standard surgical procedure is called a microdiskectomy). Further, both treatment groups received an additional 6 supervised active rehabilitation sessions and an education program.
After a year, analysis of both groups revealed that 60% of the spinal manipulation group benefited from treatment to the SAME degree as the surgical group. Further, the 40% who did not benefit to the same degree, subsequently underwent microdiskectomy surgery and benefitted to the same degree as the initial surgery group.

So what does this all mean?

Firstly, given that surgery has known risks that greatly exceed those of spinal manipulation, it is apparent that chiropractic treatment is a safe and effective treatment option. It’s also important to note that choosing the non-surgical route does not in any way worsen the outcome of surgery – should that become the treatment of choice later on.

The authors stated “Our research supports spinal manipulation performed by a doctor of chiropractic is a valuable and safe treatment option for those experiencing symptomatic lumbar disc herniation failing traditional medical management. These individuals should consider spinal manipulation as a primary treatment, followed by surgery if unsuccessful.”

As a side note, the authors of this (American) study noted that over 200,000 miscodiskectomies are performed annually in the United States at a direct cost of $5 billion, or $25,000 per procedure. The authors then calculated the total cost of the chiropractic treatments (at $100 per treatment), or $2,100 in total. This is a difference of $22,900 per patient compared to the surgery group, and a system-wide savings of $2.75 billion dollars annually in the U.S. In my opinion, those numbers speak volumes.

As always, I welcome your questions and feedback.

Yours in health,

Dr. Michael Carney
B.Sc. (Hons Kin), D.C., D.Ac., C.S.C.S

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