Association Between Spinal Manipulative Therapy and Lumbar Spine Reoperation After Discectomy: A Retrospective Cohort Study
Association Between Spinal Manipulative Therapy and Lumbar Spine Reoperation After Discectomy: A Retrospective Cohort Study
SOURCE: BMC Musculoskelet Disord 2024 (Jan 10); 25 (1): 46
Robert J. Trager, Jordan A. Gliedt Collin M. Labak,Clinton J. Daniels, and Jeffery A. Dusek
Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, OH, USA.
Background: Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years’ follow-up.
Methods: We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits.
Results: Following propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35-0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6).
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