Research update: Surgery vs chiropractic care for sciatica

Surgery vs chiropractic care for sciatica

In this month’s research update we review a study that compares the success of spinal manipulation (chiropractic adjustments) vs that of surgery for sciatic pain. Sciatic pain is nerve pain that courses down the back of your leg due to a pinched nerve in your low back. The nerve is often pinched by a bulging or herniated disc and can cause severe pain, numbness, tingling, and weakness in your leg. If you have any of these symptoms and show up at your doctor’s office, you could end up undergoing a whole spectrum of treatments and tests. A common protocol is to treat a problem like this with conservative care first, unless immediate surgery is warranted. Then consider surgery as a last option if all else fails. As this study demonstrates, “conservative care” can mean any number of things. From the medical perspective, a course of conservative care can go as follows: Oral pain medications, muscle relaxants, and a physical therapy referral. If this fails, steroid injections may be ordered as a final “conservative” approach prior to surgery.

The beauty of this study is that the group that underwent chiropractic treatment had already received at least three months of other conservative treatments that had failed to resolve their pain. After all was said and done, chiropractic care out performed the other non-operative treatments and showed very similar results as surgery, as shown in the graph above. This demonstrates that, while not the only option, chiropractic care should be considered as a valid first option  in the treatment of sciatica. Surgery can be quite effective, but one should note the potential risks and failure rate associated with surgery. If there is another option, it should be taken, especially if it is natural and has fewer potential risks and side effects. Be an educated consumer and patient. Advocate for yourself and ask your doctor what other options there are besides drugs and surgery. If those are necessary options, then ask what the risks and side effects are so you are clear about what you can expect.

Why your back pain diagnosis may be overrated

Low back pain x-ray diagnosis
Lumbar spine x-ray

In the most recent issue of “The Back Letter” the author summarizes findings of a task force employed by the National Institutes of Health (NIH) to set new research standards on low back pain. Their principle goal was to establish a classification system of chronic low back pain based on the anatomical causes of the pain. What was the result? They failed. The problem is that low back pain is too complex to just file it nicely into different categories. Here are some key points highlighted by the article:

  • It would seem easy to classify low back pain based off of diagnoses such as sciatica, disc herniations, and stenosis, but researchers and clinicians often have differing definitions of these conditions. This means that your stenosis may not look anything like the next guy’s stenosis, and they may not respond similarly to the same treatment.
  • Even with the amazing imaging technology available to us (MRI, CT scan, x-ray, ultrasound), the actual cause of your pain is not always clear. Numerous studies have shown that imaging findings do not correlate to symptoms as well as we think.

And the kicker…

  • “Tens of thousands of patients every year receive powerful medications and undergo physical treatments, injections, and surgery for spinal conditions that have never been proven to be primary causes of low back pain (The Back Letter, Vol. 29, No. 8, 2014. Lippincot, Williams & Wilkins).”

The bottom line is, don’t take your low back pain diagnosis at face value, and definitely don’t jump into anything that you are unsure of (injections, lumbar fusion, etc) without trying more conservative options first.

This is the fight that chiropractors have been fighting since the profession’s inception. Chiropractic is a safe, non-surgical, drug-free way to treat many of these common low back pain diagnoses that the medical world is having such a difficult time classifying and researching. I always tell my patients on their first visit that unless I really feel it is necessary, I probably won’t take x-rays.  We will proceed with a series of treatments to address the misalignments and joint restrictions I find in their physical exam and if their pain doesn’t improve, then we will take x-rays or order an MRI. More often than not, they will get better before we ever need any imaging. What a great model of spine care! This is why chiropractic has been shown in multiple studies to be so cost effective; the treatments are very affordable and fewer advanced tests and invasive procedures are needed when people see their chiropractor first.

Rant over. Have a healthy day!

-Dr. T