Chiropractics vs Back Surgery

Comparing the Risks: Spinal Manipulation versus Back Surgery 

While most people seeking medical care for back or neck pain recognize that they may have treatment options (often including chiropractic care and surgery), many do not understand the potential benefits and risks associated with those choices.

Patients who ask family, friends or coworkers for advice all too often hear secondhand stories about healthcare “miracles” or “nightmares” experienced by a friend’s uncle, a wife’s boss or a father’s golfing buddy.

The clinical facts—on the other hand—are often less accessible to the average person and tend to leave a smaller impression. However, for those who want a broader perspective on their treatment options, there are several high-quality research resources available. The American Journal of Medicine and Spine (among others) have featured information on the risks involved with surgery and spinal manipulation.

Headline:  Both Surgery and Manipulation Present Risks

Patients who are suffering with neck pain and considering both surgery and chiropractic treatment should be aware of the risks and discuss them openly with their healthcare providers.

In the case of any surgery, there may be serious complications from anesthesia, excessive bleeding, blood clots that lead to pulmonary embolism and infection. These general risks are added to the more specific risks of surgery on the spine. These may include a dural tear (the dura surrounds the spinal cord and a tear can cause leaking of cerebrospinal fluid), spinal cord injury and persistent or increased pain from an unsuccessful procedure.

Spinal manipulation may also cause dangerous complications. Spinal manipulation has been associated with disc herniation, cauda equina syndrome (pain, weakness or loss of bladder and bowel function) and vertebrobasilar accident (a tear in a major artery of the neck). These complications can be just as serious as the complications associated with surgery. 

If similarly severe complications may result from either course of treatment, how can a patient weigh the risk of each option? Managing risk isn’t just about understanding “worst-case”-type scenarios, it’s also about understanding how likely these and other complications are to occur. This is where some additional research findings can help. 

How Frequently Do Serious Complications Actually Occur?

In April 2010, the journal Spine (published by Lippincott Williams & Wilkins) included an article that summarized the incidence of adverse events in spinal surgery based on the authors’ review and analysis of the existing literature.

They found complication rates for spinal surgery ranging from 5% to 19%. Similarly, the American Journal of Medicine in 2002 published the results of a study that examined the incidence of serious adverse events for spinal manipulation. By comparison, researchers involved in that work reported complication rates ranging from one out of every 400,000 manipulations to one out of every two million.

So now we can see that the risk of a serious adverse event from spinal manipulation is extremely low relative to the risk posed by surgery. That’s one reason that the Mayo Clinic and many other reliable healthcare organizations around the world consider spinal manipulation very safe when performed by someone trained and licensed to provide this type of chiropractic care.

Whenever we talk about risk, it’s always important to remember that almost everything we do can be ‘associated’ with some type of adverse event. Driving a car, handling scissors, and even eating dinner can all lead to serious complications. The best way to handle these risks, including the risks of spinal manipulation, is to understand them and keep them in perspective.

Healthcare providers are uniquely qualified to help you do that. If you or someone you care about is interested in chiropractic care—including its potential benefits and risks — please call Dr. Wintermute at (949) 559-7999 to make an appointment.

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References
 
Dekutoski, MD, M. B., Norvell, PhD, D. C., Dettori, PhD, J. R., Fehlings, MD, PhD, FRCSC, FACS, M.G., & 

Chapman, MD, J. R. (2010). Surgeon Perceptions and Reported Complications in Spine Surgery. Spine, 35(9S).  Retrieved August 31, 2011, from http://www.medscape.com/viewarticle/721611

Staff, M. C. (n.d.). Chiropractic adjustment: Risks - MayoClinic.com. Mayo Clinic. Retrieved August 31, 2011, from http://www.mayoclinic.com/health/chiropractic-adjustment/MY01107/DSECTION=risks

Stevinson, MS, C., & Ernst, MD, PhD, E. (2002). Risks Associated With Spinal Manipulation. The American Journal of Medicine, 112(7), 566-571. Retrieved August 31, 2011, from http://www.sciencedirect.com/science/article/pii/S0002934302010689 

Surgery or Chiropractic for Chronic Sciatica Sufferers?

Pain coming from compression or irritation of the sciatic nerve is called sciatica. Sciatica — which can include pain, tingling, numbness and muscle weakness — is really a symptom indicating an underlying problem, not a diagnosis in and of itself. This article will explore in detail the findings of a recent controlled study comparing spinal manipulation (chiropractic) and surgery for people whose sciatica did not respond to traditional medical treatment approaches.

The study discussed here was conducted by the National Spine Center in Alberta Canada and published in October of 2010 in the Journal of Manipulative and Physiological Therapeutics. The 40 study participants all had sciatica lasting over 3 months which had not responded to treatment with pain medications, lifestyle modifications, physical therapy, massage therapy or acupuncture. They had all been referred by their primary care physicians to spinal surgeons who had deemed them appropriate surgery candidates.

Instead of having all the patient proceed with surgery, they were split into two groups — one group to undergo a surgical microdiscectomy and the other group to be treated with standardized chiropractic spinal manipulation by a single chiropractor. (If not satisfied with the results they obtained from their assigned method, the patients were allowed to switch to the other treatment plan after 3 months.)

So what happened? Both groups made significant improvements over baseline scores — meaning that they saw noticeable improvements whereas previous approaches had failed. A full 60% of the study participants benefitted from chiropractic spinal manipulation to the SAME degree as if they underwent surgery. And, after 1 year there was no difference in outcome success based on the treatment method. That means that a full 60% of people referred for surgery by their primary care physicians and accepted as surgical candidates by the neurosurgeon could actually get similar results with chiropractic. That is a lot of potentially unnecessary cutting, anesthesia and ER time.
 
There is one paragraph in the results section of this study that is easy to overlook, but incredibly important. There were originally 120 candidates of which 60 met the study criteria and were asked to participate. Of these 60, 20 refused. Why? Because they had never been offered spinal manipulation as an alternative to surgery! They didnít want to participate in the study and be randomly placed in the surgery group without first trying the spinal manipulation! This is incredibly telling. Not only does it demonstrate that there is still a lot of education about chiropractic that needs to happen among the public and among primary care providers, it also demonstrates that people understand the risks and costs of surgery and want to exhaust other possibilities first.

This was the first study to ever look at people who had failed traditional medical management of sciatica. Currently most patients that fail "conservative care" are referred for a surgical evaluation. Now we know that 60% of these folks could avoid surgery and get similar long-term outcomes with chiropractic.
Please share this article with anyone considering surgery for sciatica.