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Dr Laurent Grange (Rheumatologist)
According to a retrospective American study, adults who consult a chiropractor to undergo manipulation in the context of a herniated disc or sciatica would undergo less disc surgery than others. Is seeing a bonesetter the solution?
In the treatment of chronic pain, classical medicine can often find support in complementary medicine. Thus, when it comes to back pain, many patients also consult an osteopath or a chiropractor in order to find some comfort. But according to an American study conducted by the University of Cleveland, the benefits of chiropractic in particular would go beyond pain management: this spinal manipulation, focused on musculoskeletal conditions, would go in favor of a reduction in spine surgery.
In the numbers, spinal manipulation reduces the need for surgery
In this retrospective cohort study, the researchers thus selected adult patients, aged 18 to 49, from a US network of medical records of 101 million patients in data compiled from 2012 to 2022. 5,785 patients who initially received chiropractic spinal manipulative therapy were identified, matched with an equal number of patients who received other forms of medical care for their low back pain. The authors used a statistical technique called “propensity score matching” to control for variables that may influence the likelihood of patients undergoing discectomy.
By comparing data from the two selected groups, the authors found that patients who initially received chiropractic spinal manipulation for their low back pain were significantly less likely to undergo lumbar discectomy during the two-year follow-up.
- At one year follow-up, 1.5% of patients in the chiropractic cohort had undergone a discectomy, compared with 2.2% of patients in the cohort receiving other care;
- At two years of follow-up, 1.9% of patients in the chiropractic cohort had undergone a discectomy, compared to 2.4% of patients in the cohort receiving other care.
An encouraging result in favor of a reduction in surgeries, but which remains for the time being in a retrospective state and which would however require a randomized and controlled trial to reach a conclusion according to the authors of the study themselves.
Too flimsy data to conclude on a serious alternative to date
Asked about this study and the benefits of chiropractic, Laurent Grange, rheumatologist at the Grenoble University Hospital, and member of the Doctissimo expert committee prefers to take tweezers with the conclusions envisaged:
“This is a positive study, but difficult to establish here that chiropractic will reduce the risk of surgery, the biases here are too numerous: already, it is a retrospective analysis, that is to say conducted on a database, and with relatively weak evidence: we do not know the comorbidity of the patients analyzed, nor the manipulation techniques used, nor for how long… This greatly limits the conclusions. And that is not enough to recommend this method to the French population.”
However, the rheumatologist does not exclude the possible benefits of chiropractic or osteopathy on back pain, but he wishes to respond with a message of caution:
“Osteopathy or chiropractic must intervene as a complementary method in a pathology, not as an alternative. In the case of herniated disc or lumbosciatica in particular, the first reflex must not be manipulation, but consultation with a doctor general practitioner or rheumatologist, before turning to other paths for certain pathologies. It is important to say, because we still see a lot of complications in the office. Manipulation can also aggravate cases especially during herniated discs ” he concludes.