Chiropractic spinal manipulation could help people avoid lower back surgery

CLEVELAND — Chiropractic care can be a controversial topic for some, but new research argues that those with lower back pain who have their “back cracked” are more likely to avoid surgery later on.

Specifically, researchers say those who receive chiropractic spinal manipulation for pain due to a herniated disc or radiculopathy (injury to spinal nerves) early on are less likely to undergo surgery to repair or remove their disc within the next two years.

Spinal manipulation is the most common technique chiropractors practice. It includes a range of hands-on treatments directed at the joints of the spine. While chiropractic spinal manipulation has been found to be effective for treating lower back pain, there has been limited research that explores whether the treatment reduces the need for spinal surgery.

To delve deeper, Robert J. Trager, chiropractic physician at Connor Whole Health, University Hospitals, and his team conducted a retrospective study by selecting adults between the ages of 18 and 49 from a 101 million-patient United States health records network. The set included patient data from 2012 to 2022. To control for patients with a high severity of pain, study authors excluded them from the study due to their likely need for surgery regardless of treatment. The authors identified 5,785 patients who received chiropractic spinal manipulation therapy and the same number of those who received other medical care for pain management.

The team then used a statistical technique called propensity score matching, which can reduce observational biases that can be present in these kinds of studies. The matching technique was able to control for variables that could potentially influence the likelihood that patients would go through with surgery. They matched patients from both cohorts according to factors like age, sex, obesity, smoking, previous injections, and medications.

Chiropractic patients saw a noticeable drop in surgeries

Researchers discovered that patients who received chiropractic spinal manipulation for their lower back pain were significantly less likely to get a discectomy (removal of a herniated disk). At the one-year follow-up, 1.5 percent of the patients in the chiropractic group underwent the procedure. Meanwhile, 2.2 percent of patients in the non-chiropractic group did the same. At two years, results were still consistent. In the chiropractic cohort, 1.9 percent had a discectomy, compared to 2.4 percent of the patients in the group receiving other forms of care.

Study authors say this study contributes useful evidence to expand on findings from previous works that explore chiropractic surgery. Trager and the team took this research a step further, conducting the first study that examines the association between care and a decrease in discectomy likelihood. However, due to the observational nature of the project, they note that their findings do have some limitations and does not definitely establish a causal link between chiropractic care and less need for back surgery.

The findings are published in the journal BMJ Open.

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