“Manipulation or Microdisketomy for Sciatica? A Prospective Randomized Clinical Study,” (Journal of Manipulative and Physiological Therapeutics, October 2010, Vol. 33 Iss. 8, p: 576-584), researchers concluded that spinal manipulation was just as effective as microdiskectomy for patients struggling with sciatica secondary to lumbar disk herniation. The patient population studied included people experiencing chronic sciatica (symptoms greater than six months) that had failed traditional, medical management. Overall, 60 percent of patients who received spinal manipulation benefited to the same degree as those who underwent surgery.
“To our knowledge, this is the first, randomized trial that directly compared spinal manipulation, which in this study was delivered by a Doctor of Chiropractic (D.C. or DC)
” says Dr. Gordon McMorland, who co-authored the paper with neurosurgeons Steve Casha, MD, PhD, FRCSC FRCSC Fellow of the Royal College of Surgeons of Canada
, Stephan J. du Plessis, MD, and R. John Hubert, MD, PhD, FRCSC, FACS FACS Fellow of the American College of Surgeons.
“Sciatica is a serious spinal condition that causes pain, numbness, or weakness in one or both legs. Many times when symptoms become debilitating and without further help, surgery is prescribed to alleviate discomfort. But surgery is not without financial and physical drawbacks.”
According to the study, “Outpatient Lumbar Microdiscectomy: A Prospective Study in 122 Patients”, more than 200,000 microdiskectomies are performed annually in the United States, at a direct cost of $5 billion, or $25,000 per procedure. In this year-long study, consenting participants were chosen randomly to receive either an average of 21 chiropractic sessions over a year or a single microdiskectomy, both with the additional integration of six supervised active rehabilitation sessions and a patient education program. If cost is assumed at $100 per chiropractic visit, there is a direct, total savings of $22,900 per manipulation patient. System-wide, this could save $2.75 billion dollars annually.
“After a year, no significant complications were seen in either treatment group, and the 60 percent patients who benefitted from spinal manipulation improved to the same degree as their surgical counterparts,” says Dr. McMorland, who also points out that, “The 40 percent of patients who were not helped by manipulation did receive subsequent surgical intervention. These patients benefitted to the same degree as those that underwent surgery initially, suggesting there was no detrimental effect caused by delaying their surgical treatment.”
“Our research supports spinal manipulation performed by a doctor of chiropractic is a valuable and safe treatment option for those experiencing symptomatic LDH, failing traditional medical management. These individuals should consider spinal manipulation as a primary treatment, followed by surgery if unsuccessful.”
de Almeida BS, Sabatino JH, Giraldo PC.
Department of Gynecology, UNICAMP (The State University of Campinas), Campinas, SP, Brazil. firstname.lastname@example.org
OBJECTIVE: Spinal manipulation with high-velocity and low-amplitude (HVLA) manipulation is frequently used for the treatment of lumbopelvic pain; however, the effect on the pelvic floor has been poorly studied in the past. The objective of this study was to quantify the intravaginal pressure (IVP) and the basal perineal tonus (BPT), measured in terms of pressure, before and after the HVLA manipulation in patients without neuromuscular and skeletal dysfunctions.
METHODS: In this experimental, noncontrolled, nonrandomized study, IVP was obtained through a perineometer introduced into the volunteers’ vagina while in dorsal horizontal decubitus. Forty young, healthy university volunteer women with no history of vaginal delivery participated. All voluntary contractions of the perineal muscles were measured in 3 different ways: phasic perineal contraction (PPC), tonic perineal contraction, and perineal contraction associated to accessory muscles. New pressure measurements were obtained immediately after the HVLA manipulation on the volunteers’ sacrum. The pressures were registered and transcribed directly to a personal computer with specific software.
RESULTS: The average IVPs obtained in millimeters of mercury before and after the HVLA manipulation were 56.01 (+/-25.54) and 64.65 (+/-25.63) for PPC, 445.90 (+/-186.84) and 483.14 (+/-175.29) for tonic perineal contraction, and 65.62 (+/-26.56) and 69.37 (+/-25.26) for perineal contraction associated to accessory muscles, respectively. There was significant statistical variation only for PPC (P = .0020) values. The BPT increased regardless of the type of contraction (P < .05).
CONCLUSION: High-velocity and low-amplitude manipulation of the sacrum was associated with an increase of PPC and of BPT in women who had no associated osteoarticular diseases. These preliminary discoveries could be helpful in the future study of the treatment of women with perineal hypotony. (c) 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.