Abstract
Objective
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).
Methods
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.
Results
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.
Conclusions
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.
Key Indexing Terms
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Article info
Publication history
Accepted:
June 8,
2010
Received in revised form:
March 17,
2010
Received:
December 30,
2009
Identification
Copyright
© 2010 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
