Abstract
Objectives
The purpose of this study was to compare self-reported pain and “improvement” of patients
with symptomatic, magnetic resonance imaging–confirmed, lumbar disk herniations treated
with either high-velocity, low-amplitude spinal manipulative therapy (SMT) or nerve
root injections (NRI).
Methods
This prospective cohort comparative effectiveness study included 102 age- and sex-matched
patients treated with either NRI or SMT. Numerical rating scale (NRS) pain data were
collected before treatment. One month after treatment, current NRS pain levels and
overall improvement assessed using the Patient Global Impression of Change scale were
recorded. The proportion of patients, “improved” or “worse,” was calculated for each
treatment. Comparison of pretreatment and 1-month NRS scores used the paired t test. Numerical rating scale and NRS change scores for the 2 groups were compared
using the unpaired t test. The groups were also compared for “improvement” using the χ2 test. Odds ratios with 95% confidence intervals were calculated. Average direct procedure
costs for each treatment were calculated.
Results
No significant differences for self-reported pain or improvement were found between
the 2 groups. “Improvement” was reported in 76.5% of SMT patients and in 62.7% of
the NRI group. Both groups reported significantly reduced NRS scores at 1 month (P = .0001). Average cost for treatment with SMT was Swiss Francs 533.77 (US $558.75)
and Swiss Francs 697 (US $729.61) for NRI.
Conclusions
Most SMT and NRI patients with radicular low back pain and magnetic resonance imaging–confirmed
disk herniation matching symptomatic presentation reported significant and clinically
relevant reduction in self-reported pain level and increased global perception of
improvement. There were no significant differences in outcomes between NRI and SMT.
When considering direct procedure costs, the average cost of SMT was slightly less
expensive.
Key Indexing Terms
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Article info
Publication history
Published online: May 24, 2013
Accepted:
December 27,
2012
Received in revised form:
December 24,
2012
Received:
August 24,
2012
Identification
Copyright
© 2013 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
