A report on the scientific literature
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
William J. Owens DC, DAAMLP
Here are the facts:
When conservative therapies for low back pain (LBP) are not effective, elective surgery may be proposed to these patients. In the United States, it has been estimated that between 6 and 7.5% of chronic LBP patients undergo spinal surgery. The main reasons for surgical treatment of
LBP are high levels of pain, disability and underlying pathology. Patients with disc degeneration represent a large part of spinal surgerypractice. Over the last 20 years, a new technology, disc replacement, has become increasingly popular because it is believed to maintain or restore the integrity of spinal movement and minimize the side-effects compared to fusion. Although disc replacement may relieve a patient from pain and related disability, soreness and stiffness of the lumbo-pelvic region seem to be common aftermaths of the surgery.
While this type of surgery, or the necessity for surgery is not the topic of this article, the authors feel strongly that the decision for spinal surgery, predominantly an elective procedure should be made via a team approach. The patient must (not should) consult both the non-surgical health care provider as well as the surgical provider and those specialist must have a level of dialogue to reach a consensus of the best course of care weighing all of the risks vs. benefits with the patient. No one provider has all of the answers.
Spinal manipulation (adjustments) is one of the recommended conservative therapies for low back pain. Usually, adverse events occur in the first 24 to 48 hours, are benign and resolve completely in a few days. Major complications, for which the overall prevalence is unknown, include increased pain from disc herniation (transient) or cauda equina syndrome (estimated to be less than 1/ 3,700,000 to 1/1,000,000 of lumbar manipulations) and are considered irreversible. Since disc prostheses are believed to restore normal segmental range of motion and reduce potential residual instability, patients with total disc replacement could probably be manipulated similarly to patients with specific low back pain by standard side posture spinal manipulation to alleviate residual pain.
After disc replacement, patients with residual, chronic low back pain would present spinal manipulation side-effects similar to those generally described in a chronic low back pain population.
The main objective of a 2010 study was to evaluate the potential adverse events of lumbar spine manipulations in disc replacement surgery patients. The most frequent side-effects reported were a slight increase in pain as well as minor to moderate lower back stiffness. Both side effects are frequently seen in non-surgical LBP patients after manipulation. In a recent study, Rubinstein described post-spinal manipulation adverse events as being mild to moderate in intensity, with little or no influence on daily activities. He also showed that such events are brief, with spontaneous recovery and typically lasting no more than a few days.
In the same article, it was mentioned that adverse events usually appear at the first treatment and are the result of muscles accommodating to the correct positioning of the spine and need a day or so to “calm down.”
In a recent systematic review of safety of chiropractic intervention, the frequency of adverse events reported after a chiropractic intervention varied between 33 to 60.9%, regardless of treatment type and the patients' clinical presentation and again, is a minor to moderate stiffness and resolves in a very short time spontaneously. Regarding severe adverse reactions; in the present study, none of the patients had severe and irreversible reactions after spinal manipulation.
These studies along with many others conclude that a drug-free approach of chiropractic care is one of the best solutions for patients with post surgical low back pain. To find a qualified doctor of chiropractic near you go to the US Chiropractic Directory at www.USChiroDirectory.coman search your state.