The purpose of this study was to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH).
One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3-4, L4-5, or L5-S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months.
Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received. However, 3 patients crossed over from surgery to spinal manipulation and failed to gain further improvement. Eight patients crossed from spinal manipulation to surgery and improved to the same degree as their primary surgical counterparts.
Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.
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- The use of the percentage change in Oswestry Disability Index score as an outcome measure in lumbar spinal surgery.Spine. 1994; 19: 2139-2143
- Body height, obesity, and risk of herniated lumbar intervertebral disc.Spine. 1987; 12: 469-472
- Individual factors, occupational loading, and physical exercise as predictors of sciatic pain.Spine. 2002; 27: 1102-1109
- Factors predicting outcomes of mechanical sciatica: a review of 1092 cases.Joint Bone Spine. 2004; 71: 567-571
- A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors.J Manipulative Physiol Ther. 1995; 18: 335-342
- Non-operative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study.Spine. 1989; 14: 431-437
- Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.Spine J. 2006; 6: 131-137
- Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review.Eur Spine J. 2007; 16: 881-899
- A critical look at the treatment for low back pain.Scand J Rehabil Med Suppl. 1979; 11: 143-147
- Low back pain hospitalization: recent United States trends and regional variations.Spine. 1994; 19: 1207-1213
- Spine update: the natural history of disc herniation and the influence of intervention.Spine. 1994; 19: 2234-2238
- Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10-year results from the maine lumbar spine study.Spine. 2005; 30: 927-935
- Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to10 year results from the Maine lumbar spine study.Spine. 2005; 30: 936-943
- A study of the results following rotatory manipulation in the lumbar intervertebral disc syndrome.J Bone Joint Surg AM. 1964; 46: 517-524
- Effectiveness of microdiscectomy for lumbar disc herniation: a randomized controlled trial with 2 years of follow-up.Spine. 2006; 31: 2409-2414
- Surgical vs nonoperative treatment for lumbar disc herniation: the spine patient outcomes research trial (SPORT) observational cohort.JAMA. 2006; 296: 2451-2459
- The spine patient outcomes research trial (SPORT): a randomized trial.JAMA. 2006; 296: 2441-2450
- Spinal manipulation in the treatment of low back pain.Can Fam Physician. 1985; 31: 535-540
- Lumbar intervertebral disc herniation: treatment by rotational manipulation.J Manipulative Physiol Ther. 1989; 12: 220-227
- Treatment of multiple lumbar disc herniations in an adolescent athlete utilizing flexion distraction and rotational manipulation.J Manipulative Physiol Ther. 1993; 16: 185-192
- Distraction manipulation reduction of an L5-S1 disk herniation.J Manipulative Physiol Ther. 1993; 16: 342-346
- Manipulative therapy in lower back pain with leg pain and neurological deficit.J Manipulative Physiol Ther. 1998; 21: 288-294
- Side posture manipulation for lumbar intervertebral disk herniation: review of the literature.J Manipulative Physiol Ther. 1993; 16: 96-103
- Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management.Am J Phys Med. 1982; 61: 273-278
- Kirkaldy-Willis WH Burton CV Managing low back pain. 3rd edition. Churchill Livingstone, New York1992: 263-281
- Liebenson C Rehabilitation of the spine: a practitioner's manual. Williams & Wilkins, Baltimore, MD1996: 13-43
- Haldeman S Chapman-Smith D Petersen DM Guidelines for chiropractic quality assurance and practice parameters, Proceedings of the Mercy Center Consensus Conference Aspen Publishers, 1993
Henderson D, Chapman-Smith D, Mior S, Vernon H, editors. Clinical guidelines for chiropractic practice in Canada. Proceedings of a Consensus Conference Commissioned by the Canadian Chiropractic Association. J Can Chiropr Assoc 1994; Suppl 38(1).
- Biostatistics 301; repeated measurement analysis.Singapore Med J. 2004; 45: 354-369
- Biostatistics 301A. Repeated measurement analysis (mixed models).Singapore Med J. 2004; 45: 456-461
- Developing a valid and reliable measure of health outcome for patients with low back pain.Spine. 1994; 19: 1887-1896
- A critique of the surgical management of lumbar disc disease in private neurosurgical practice.Spine. 1984; 9: 500-504
- Elective discectomy for herniation of lumbar disc. Additional experience with an objective method.J Bone Joint Surg. 1990; 72A: 230-237
- Seven-year clinical follow-up after lumbar disc surgery: results and predictors of outcome.Br J of Neurosurg. 1999; 13: 178-184
- Spinal manipulation for the treatment of chronic low back and leg pain: an observational trial.in: Buerger AA Greenman PE Empirical approaches to the validation of manipulative therapy. Charles C Thomas, Springfield1985
- Treatment of lumbar intervertebral disc protrusions by manipulation.Clin Orthop. 1987; 215: 47-55
Accepted: June 8, 2010
Received in revised form: March 17, 2010
Received: December 30, 2009
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