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Low Back Pain

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 |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

The Chiro.Org Blog

SOURCE:   AJNR Am J Neuroradiol 2015 (Dec)

  OPEN ACCESS   

W. Brinjikji • F.E. Diehn • Jarvik • C.M. Carr • Kallmes • 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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Association Between Chiropractic Spinal Manipulation and Cauda Equina Syndrome in Adults With Low Back Pain: Retrospective Cohort Study of US Academic Health Centers

By |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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Association Between Spinal Manipulative Therapy and Lumbar Spine Reoperation After Discectomy: A Retrospective Cohort Study

By |February 18, 2024|Failed Back Surgery Syndrome, Low Back Pain, Lumbosacral Radiculopathy|

Association Between Spinal Manipulative Therapy and Lumbar Spine Reoperation After Discectomy: A Retrospective Cohort Study

The Chiro.Org Blog

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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Global, Regional, and National Burden of Low Back Pain, 1990–2020, Its Attributable Risk Factors,
and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021

By |May 24, 2023|Global Burden of Disease, Global Spine Care Initiative, Low Back Pain|

Global, Regional, and National Burden of Low Back Pain, 1990–2020, Its Attributable Risk Factors, and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021

The Chiro.Org Blog

SOURCE:   Lancet Rheumatology 2023 (May 23); 5 (6): E316-E329
Manuela L Ferreira, Katie de Luca, Lydia M Haile, Jaimie D Steinmetz, Garland T Culbreth, et al.

Faculty of Medicine and Health,
Institute of Bone and Joint Research,
The Kolling Institute, Northern Clinical School,
University of Sydney,
Sydney, NSW 2064, Australia.

Background   Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021.

Methods   Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates.

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Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

By |April 29, 2023|Chiropractic Management, Initial Provider, Low Back Pain|

Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther 2021 (Nov); 44 (9): 683–689
Brian R. Anderson, DC, MPH, MS, PhD, Steve W. McClellan, MS

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA.


FROM:  
Houweling, JMPT 2015    Liliedahl, JMPT 2010

Objective:   The purpose of this study was to evaluate the relationship between procedures and care patterns in back pain episodes by analyzing health insurance claims.

Methods:   We performed a retrospective cohort study of insurance claims data from a single Fortune 500 company. The 3 care patterns we analyzed were initial spinal manipulative therapy, delayed spinal manipulative therapy, and no spinal manipulative therapy. The 3 procedures analyzed were imaging studies, injection procedures, and back surgery. We considered “escalated care” to be any claims with diagnostic imaging, injection procedures, or back surgery. Modified-Poisson regression modeling was used to determine relative risk of escalated care.

Results:   There were 83,025 claims that were categorized into 10 372 unique patient first episodes. Spinal manipulative therapy was present in 2,943 episodes (28%). Initial spinal manipulation was present in 2,519 episodes (24%), delayed spinal manipulation was present in 424 episodes (4%), and 7,429 (72%) had no evidence of spinal manipulative therapy. The estimated relative risk, adjusted for age, sex, and risk score, for care escalation (eg, imaging, injections, or surgery) was 0.70 (95% confidence interval 0.65–0.75, P < .001) for initial spinal manipulation and 1.22 (95% confidence interval 1.10–1.35, P < .001) for delayed spinal manipulation with no spinal manipulation used as the reference group.

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Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey

By |April 16, 2023|Chronic Neck Pain, Chronic Spinal Pain, Low Back Pain|

Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey

The Chiro.Org Blog

SOURCE:   Int J Environ Res Public Health 2023 (Apr 3); 20 (7): 5369

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Katie de Luca, Patricia Tavares, Haiou Yang, Eric L Hurwitz, Bart N Green, Hannah Dale, Scott Haldeman

Discipline of Chiropractic,
School of Health, Medical and Applied Science,
CQ University,
Brisbane, QLD 4701, Australia.


FROM:   J Pain Res. 2021

Spinal pain and chronic health conditions are highly prevalent, burdensome, and costly conditions, both in the United States and globally. Using cross-sectional data from the 2016 through 2018 National Health Interview Survey (n = 26,926), we explored associations between spinal pain and chronic health conditions and investigated the influence that a set of confounders may have on the associations between spinal pain and chronic health conditions. Variance estimation method was used to compute weighted descriptive statistics and measures of associations with multinomial logistic regression models. All four chronic health conditions significantly increased the prevalence odds of spinal pain; cardiovascular conditions by 58%, hypertension by 40%, diabetes by 25% and obesity by 34%, controlling for all the confounders.

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