If you cut your finger, do you apply a bandaid or amputate?

I was telling a patient this morning that we have nearly a 100% success rate in starting patients who have been referred for neck or back surgery, and helping them fully recover--without undergoing surgery.

I have a patient right now who showed advanced degenerative disc changes in the neck, and had weakness and loss of reflexes in the left arm.  He came here first (on the referral of a friend) but I have no doubt that had he gone to a medical doctor first he would have ended up with a recommendation for surgery.  He's not fully recovered yet, but we're over the hump.  The arm is back to full strength with normal reflexes and his pain is reduced more than 75%.  He's continued to work throughout his course of care.  Now begins the more challenging work of correcting the alignment of his neck ( it was a loss of normal curvature that led to the degenerative disc damage) and teaching him how to keep it that way.

Although I really want to help these people and keep them out of surgery, it's comforting to know to know in the back of my mind that if I can't help them, they can still go with surgery.  There's nothing about our care that reduces or eliminates any of the other options available, should we be unsuccessful.  It doesn't work the other way around.

It isn't just spine surgery either.  We recently helped a very nice lady that had been removed from work and told she needed a total knee replacement.  I took a film and found that there was thinning of the lateral meniscus (outside knee cartilage), and there was a lot of instability when I held her knee firmly and moved her leg side to side.  We talked about the recommendation for surgery and agreed that it made sense to do everything we could to improve her knee function, and if at any time she decides she'd rather go ahead and have the surgery, she could do so.  The next time she went back to the surgeon, he told her she was doing well enough that she could postpone the surgery for now and return to work with some restrictions.  She may eventually undergo knee surgery, but she has a better quality of life now, and because of the progress she's made, I believe she'd recover better and faster from surgery if that ever does occur.  She's continuing to work hard to make sure it doesn't.

This has been a roundabout way of leading up to a new study that was just published, showing that 60% of patients who were confirmed surgical candidates for low back and leg pain recovered fully under chiropractic care.. and didn't undergo surgery.  These were patients that had already undergone 3 months of medical management and failed to improve.  These were patients that would have undergone surgery.

This was achieved with "run of the mill" average chiropractic care, consisting only of "standardized spinal manipulation."  I believe that some of the specialized knowledge and applications we offer allow us to achieve a much higher degree of success.

Here's another important point:  Three patients that had undergone surgery first and didn't improve--then underwent chirpractic care, didn't improve.  Of eight patients who underwent chiropractic care without improvement and then surgery.. all improved as well as the others had.  jAt the very least, chiropractic care didn't hamper their potential for improvement with surgery, and at best, it may have actually increased their chances for recovery with surgery.  None of them were worse as a result of their chiropractic care.

If the average low back surgery costs $40,000 (it's more), and the average course of corrective chiropractic care was $2,000 (it's less), and these relatively poor statistical results were reproduced--with every candidate for back surgery first undergoing a complete corrective trial of chiropractic care, routine chiropractic utilization would reduce the expenditure for back surgeries by more than 70%!

Here's the abstract from the study.

J Manipulative Physiol Ther. 2010 Oct;33(8):576-84.
Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.

McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ.

Chiropractor, National Spine Care, Calgary, Alberta, Canada. gmcmorland@nationalspinecare.com
Abstract

OBJECTIVE: The purpose of this study was to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH).

METHODS: One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3-4, L4-5, or L5-S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months.

RESULTS: Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received. However, 3 patients crossed over from surgery to spinal manipulation and failed to gain further improvement. Eight patients crossed from spinal manipulation to surgery and improved to the same degree as their primary surgical counterparts.

CONCLUSIONS: Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.
Copyright © 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.