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MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis

By Frank M. Painter|June 26, 2024|Low Back Pain, Radiology|

MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis

SOURCE: AJNR Am J Neuroradiol 2015 (Dec)

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W. Brinjikji • F.E. Diehn • Jarvik
C.M. Carr • Murad • P.H. Luetmera

Department of Neurological Surgery and Health Services,
Comparative Effectiveness Cost and Outcomes Research Center (J.G.J.)
Department of Radiology (J.G.J.),
University of Washington,
Seattle, Washington.

Background and purpose: Imaging features of spine degeneration are common in symptomatic and asymptomatic individuals. We compared the prevalence of MR imaging features of lumbar spine degeneration in adults 50 years of age and younger with and without self-reported low back pain.

Materials and methods: We performed a meta-analysis of studies reporting the prevalence of degenerative lumbar spine MR imaging findings in asymptomatic and symptomatic adults 50 years of age or younger. Symptomatic individuals had axial low back pain with or without radicular symptoms. Two reviewers evaluated each article for the following outcomes: disc bulge, disc degeneration, disc extrusion, disc protrusion, annular fissures, Modic 1 changes, any Modic changes, central canal stenosis, spondylolisthesis, and spondylolysis. The meta-analysis was performed by using a random-effects model.

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RADIOLOGY Section and the

LOW BACK PAIN Section

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A Retrospective Analysis of the Incidence of Severe Adverse Events Among Recipients of Chiropractic Spinal Manipulative Therapy

By Frank M. Painter|June 24, 2024|Adverse Events, Spinal Manipulation|

A Retrospective Analysis of the Incidence of Severe Adverse Events Among Recipients of Chiropractic Spinal Manipulative Therapy

The Chiro.Org Blog

SOURCE: Sci Rep 2023 (Jan 23); 13 (1): 1254

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Eric Chun-Pu Chu • Robert J Trager
Linda Yin-King Lee • Imran Khan Niazi

New York Chiropractic and Physiotherapy Centre,
EC Healthcare, 41/F Langham Place Office Tower,
8 Argyle Street, Kowloon, Hong Kong.

This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 SMT sessions results in a grade ≥ 3 (severe) AE. A secondary objective was to examine independent predictors of grade ≥ 3 AEs. We identified patients with SMT-related AEs from January 2017 through August 2022 across 30 chiropractic clinics in Hong Kong. AE data were extracted from a complaint log, including solicited patient surveys, complaints, and clinician reports, and corroborated by medical records. AEs were independently graded 1–5 based on severity (1–mild, 2–moderate, 3–severe, 4–life-threatening, 5–death). Among 960,140 SMT sessions for 54,846 patients, 39 AEs were identified, two were grade 3, both of which were rib fractures occurring in women age > 60 with osteoporosis, while none were grade ≥ 4, yielding an incidence of grade ≥ 3 AEs of 0.21 per 100,000 SMT sessions (95% CI 0.00, 0.56 per 100,000). There were no AEs related to stroke or cauda equina syndrome. The sample size was insufficient to identify predictors of grade ≥ 3 AEs using multiple logistic regression. In this study, severe SMT-related AEs were reassuringly very rare.

Subject terms: Adverse effects, Rehabilitation

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ADVERSE EVENTS Section

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Memorial Day: In Memory of Those Who Have Fallen

By Frank M. Painter|May 24, 2024|Announcement, Memorial|

Memorial Day: In Memory of Those Who Have Fallen

The Chiro.Org Blog

The Bivouac of the Dead

The muffled drum’s sad roll has beat
The soldier’s last tattoo’
No more on life’s parade shall meet
That brave and fallen few;

On Fame’s eternal camping ground
Their silent tents are spread;
But Glory guards with solemn round
The bivouac of the dead.

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Cost of Chiropractic Versus Medical Management of Adults with Spine-related Musculoskeletal Pain: A Systematic Review

By Frank M. Painter|May 8, 2024|Cost-Effectiveness of Chiropractic, Initial Provider, Spinal Pain|

Cost of Chiropractic Versus Medical Management of Adults with Spine-related Musculoskeletal Pain: A Systematic Review

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2024 (Mar 6); 32: 8

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Ronald Farabaugh • Cheryl Hawk • Dave Taylor • Clinton Daniels • Claire Noll • Mike Schneider • John McGowan • Wayne Whalen • Ron Wilcox • Richard Sarnat • Leonard Suiter • James Whedon

American Chiropractic Association,
2008 St. Johns Avenue,
Highland Park, Illiois. 60035
Arlington, VA, USA.

FROM: Houweling, JMPT 2015

Background: The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain.

Methods: A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain. The search included economic studies, randomized controlled trials and observational studies. All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators.

Results: The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility. Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial. All included studies were rated as high or acceptable quality. Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures.

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COST-EFFECTIVENESS Section and the

SPINAL PAIN MANAGEMENT Section and the

INITIAL PROVIDER/FIRST CONTACT Section

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Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System

By Frank M. Painter|April 24, 2024|Neurology, Subluxation|

Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System

The Chiro.Org Blog

SOURCE: Cureus 2024 (Mar 15); 16 (3): e56223

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Amy Haas • Jonathan Chung • Christopher Kent • Brooke Mills and Matthew McCoy

Foundation for Vertebral Subluxation
4390 Bells Ferry Road
Kennesaw, Georgia 30144

In this paper we synthesize an expansive body of literature examining the multifaceted influence of chiropractic care on processes within and modulators of the neuroendocrine-immune (NEI) system, for the purpose of generating an inductive hypothesis regarding the potential impacts of chiropractic care on integrated physiology. Taking a broad, interdisciplinary, and integrative view of two decades of research-documented outcomes of chiropractic care, inclusive of reports ranging from systematic and meta-analysis and randomized and observational trials to case and cohort studies, this review encapsulates a rigorous analysis of research and suggests the appropriateness of a more integrative perspective on the impact of chiropractic care on systemic physiology. A novel perspective on the salutogenic, health-promoting effects of chiropractic adjustment is presented, focused on the improvement of physical indicators of well-being and adaptability such as blood pressure, heart rate variability, and sleep, potential benefits that may be facilitated through multiple neurologically mediated pathways. Our findings support the biological plausibility of complex benefits from chiropractic intervention that is not limited to simple neuromusculoskeletal outcomes and open new avenues for future research, specifically the exploration and mapping of the precise neural pathways and networks influenced by chiropractic adjustment.

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SUBLUXATION Section

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Association Between Chiropractic Spinal Manipulation and Cauda Equina Syndrome in Adults With Low Back Pain: Retrospective Cohort Study of US Academic Health Centers

By Frank M. Painter|March 17, 2024|Cauda Equina Syndrome, Low Back Pain|

Association Between Chiropractic Spinal Manipulation and Cauda Equina Syndrome in Adults With Low Back Pain: Retrospective Cohort Study of US Academic Health Centers

The Chiro.Org Blog

SOURCE: PLoS One 2024 (Mar 11); 19 (3): e0299159
Robert J. Trager • Anthony N. Baumann • Jaime A. Perez
Jeffery A. Dusek • Romeo-Paolo T. Perfecto • Christine M. Goertz

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, Ohio, United States of America.

Background: Cauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). The study hypothesis was that there would be no increase in the risk of CES in adults with LBP following CSM compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period.

Methods: A query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing CES, incontinence, or serious pathology that may cause CES.
Patients were divided into two cohorts:

(1) LBP patients receiving CSM or
(2) LBP patients receiving PT evaluation without spinal manipulation.

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LOW BACK PAIN Section

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