Low back pain (LBP) is one of the most common reasons for health care visits, missed work, and disability in the US and around the world. Studies report that up to 84% of all people will experience LBP at some point in their lives. There are many potential causes for a person to have back pain, ranging from minor and transient to severe and chronic.
Among the most common LBP causes is lumbar disc herniation, a condition for which surgery is frequently considered as a treatment. A new research study published in January, 2024 in the journal BMC Musculoskeletal Disorders reports that Chiropractic Spinal Manipulative Therapy (SMT) may offer pain management while also lowering the odds of a second surgery for patients that are experiencing pain 1 year after their initial discectomy.
Lumbar disc herniation involves intervertebral discs which separate the spinal vertebrae. Chiropractic Therapy Assistant: A Clinical Resource Guide describes these as being “made up of fibrous cartilage, with a soft inner core, which allows them to absorb shock and permit flexibility.” When one of these discs bulges out of shape due to excessive strain, it is called a herniated or protruding disc. In more severe cases, this bulge can put pressure on the spinal nerve leading to pain, weakness or numbness. While this can occur at any point in the spinal column, it is most common in the lumbar (lower back) region.
One of the common treatments for this condition is a discectomy, where the herniated disc material is removed by a surgeon. Unfortunately, about 20% of patients who have a lumbar discectomy have pain that continues or reoccurs within the first year. Repeat surgeries tend to have a lower success rate than the primary procedures and are therefore used as a last resort. Instead, patients are treated with medications, cognitive behavioral therapy, and other physical modalities.
In the BMC study, researchers reviewed data from a US research network which aggregates health records data from over 114 million patients attending 80 academic medical centers and their affiliated hospitals and outpatient offices. They looked at records for patients who were 18 years of age or older and having a diagnosis of lumbosacral radiculopathy (LSR) or low back pain radiating down the leg(s), at least 1 year after having a discectomy. They chose the diagnosis based on being the most likely to be a candidate for repeat surgery.
Researchers divided the patients into two groups – one that received chiropractic spinal manipulation (SMT) to treat LSR at least 1 year after discectomy and the other that received care from providers other than chiropractors. The groups were matched for age, body mass index, nicotine dependence and a diagnosis of spondylolisthesis which have been shown in other studies to be related to reoperation after discectomy. Over 99% of the patient records went back 5 years prior to initial discectomy and followed for at least 2 years after the procedure.
After analysis, the researchers determined that patients who had received Chiropractic SMT were significantly less likely to have reoperation. Only 7% of the CMT group had second surgeries compared to 13% of those that did not receive chiropractic care.
Researchers state this is the first large-scale study exploring the association between SMT and spinal reoperation. They acknowledge that the patient-provider relationship, education and advice from the provider, or other non-therapeutic factors associated with receiving SMT may have had some impact on the findings. They suggest similar studies be conducted with other therapies often used after discectomy as well as studies that focus on the “patients’ reasons for pursuing or avoiding lumbar spine reoperation.” They also propose additional studies to include detailed patient-level data, patient reported outcomes including quality of life and pain medication utilization, as well as studies that include response to previous treatments before the initial surgery.
Previous research had shown that patients who sought chiropractic care were significantly less likely to require surgery. This current study suggests that even when patients have had spinal surgery chiropractic care may reduce the need for additional surgeries.
While the study did not address costs, given that surgical procedures tend to be expensive, they note that seeking chiropractic care could help reduce health care costs. The current study also did not focus on adverse events. However, researchers note “our findings of reduced lumbar spine reoperation in adults receiving SMT serve as a potential marker of safety of this treatment, suggesting that SMT may be unlikely to contribute to recurrent disc herniation requiring reoperation.”
There are many variables that can play a role in determining what treatment will be best for any given patient on any given day. Within the same diagnosis, there can be a wide range of severity, and no two patients will always respond the same to any treatment. However, more and more research is documenting what those in the chiropractic community have experienced for years – Chiropractic is a safe and effective treatment for many patients with musculoskeletal pain. When needed, the Doctor of Chiropractic can coordinate care with other health care providers in order to provide the best possible outcome for each patient, while minimizing the risks associated with many medications and surgical procedures.
If you or a loved one is experiencing low back pain, talk to your chiropractor about how conservative chiropractic treatment may help.
Trager, R.J., Gliedt, J.A., Labak, C.M. et al. Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study. BMC Musculoskelet Disord 25, 46 (2024). https://doi.org/10.1186/s12891-024-07166-x
Castillo H, Chintapalli RTV, Boyajian HH, Cruz SA, Morgan VK, Shi LL, et al. Lumbar discectomy is associated with higher rates of lumbar fusion. Spine J. 2019;19:487–92.
Yang H, Liu H, Li Z, Zhang K, Wang J, Wang H, Zheng Z. Low back pain associated with lumbar disc herniation: role of moderately degenerative disc and annulus fibrous tears. Int J Clin Exp Med. 2015 Feb 15;8(2):1634-44. PMID: 25932092; PMCID: PMC4402739.
Mayo Clinic. “Herniated Disc”. https://www.mayoclinic.org/diseases-conditions/herniated-disk/symptoms-causes/syc-20354095 accessed 1/24/2024.
Chiropractic Therapy Assistant: A Clinical Resource Guide, 2nd edition; Cole J. Hosenfeld, DC, DACBSP, Tiffany Stevens, CTA. 2018.
Tennessee Chiropractic Association. “New Research Suggests Chiropractic Associated with Reduced Odds of Discectomy” Posted: January 11, 2023. https://www.tnchiro.com/research/new-research-suggests-chiropractic-associated-with-reduced-odds-of-discectomy/ Referenced 1/25/2024.