Spinal Manipulative Treatment And Lumbar Discectomy & Initial Providers Matter

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 336: Spinal Manipulative Treatment And Lumbar Discectomy & Initial Providers Matter Today we’re going to talk about Spinal Manipulative Treatment And Lumbar Discectomy & Initial Providers Matter But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [e-mail] If you haven’t yet I have a few things you should do.

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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You have found yourself smack dab in the middle of Episode #336 Now if you missed last week’s episode, we talked about Flavored Vape Issues & Adverse Events From Cervical Spinal Manipulation. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things….. Trying to climb out of the valley again and it appears that we are. New patient number back on the rise and the days are filling up again. Today I have 57 patients. Which is honestly more than I want. I have a staff of 3 full timers in addition to a front desk person to help me do it but thats still just more than I want in one day. And only 19 tomorrow. Honestly…..couldn’t that have been spread out a little more efficiently? The answer is probably. But our front desk girl is an absolutey rock star and I’m not saying a word. She’s still a bit new and finding her way. Most of you know that scheduling is an art and when she sees we’re struggling to keep up with her schedule, she’ll adjust naturally. Is that the best way to take care of it?? No. I did send tell her at the start of the day that we are tapped out and cannot fit any more patients so she gets the message from the start. Then as far as the rest of it goes, she’ll find her way. I’d rather be scheduled heavy than light. But yeah, for an old 51 year old, 57 in one day is a little more than I can chew. I think it’s the increase in marketing and all of the changes I’ve been mentioning lately. We changed website companies, we increased our marketing and are just doing some things differently lately. And I think we are starting to see the fruits of our efforts. I’ll keep you updated on what’s up and what we’re doing. Stick around. It’s always interesting.

Item #1

Our first one today is called “Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty” by Fenton et al and published in Spine Journal in October 2023 and it’s just hot enough.

Remember, the citations can be found at chiropracticforward.com under this episode.

Fenton, Joshua J. MD, MPHa,b; Fang, Shao-You PhDb; Ray, Monika PhDb,c; Kennedy, John CCS, CDIPb; Padilla, Katrine MPPb; Amundson, Russell MDd; Elton, David DCd; Haldeman, Scott DC, MD, PhDe; Lisi, Anthony J. DCf; Sico, Jason MD, MHSf,g; Wayne, Peter M. PhDh; Romano, Patrick S. MD, MPHb,c. Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty. Spine 48(20):p 1409-1418, October 15, 2023. | DOI: 10.1097/BRS.0000000000004781

Why They Did It The objective was to compare utilization patterns for patients with new-onset neck pain by initial provider specialty.Initial provider specialty has been associated with distinct care patterns among patients with acute back pain; little is known about care patterns among patients with acute neck pain.

How They Did It Retrospective cohort study. Used Optum Labs Data Warehouse, which contains longitudinal health information on over 200M enrollees and patients representing a mixture of ages and geographical regions across the United States. Patients had outpatient visits for new-onset neck pain from October 1, 2016 to September 30, 2019, classified by initial provider specialty. Utilization was assessed during a 180-day follow-up period, including subsequent neck pain visits, diagnostic imaging, and therapeutic interventions.

What They Found

• The cohort included 770,326 patients with new-onset neck pain visits.
• The most common initial provider specialty was chiropractor (45.2%), followed by primary care (33.4%).
• Initial provider specialty was strongly associated with the receipt of subsequent neck pain visits with the same provider specialty.
• Rates and types of diagnostic imaging and therapeutic interventions during follow-up also varied widely by initial provider specialty.
• While uncommon after initial visits with chiropractors (≤2%), CT, or MRI scans occurred in over 30% of patients with initial visits with emergency physicians, orthopedists, or neurologists.
• Similarly, 6.8% and 3.4% of patients initially seen by orthopedists received therapeutic injections and major surgery, respectively, compared with 0.4% and 0.1% of patients initially seen by a chiropractor.

Wrap It Up Within a large national cohort, chiropractors were the initial provider for a plurality of patients with new-onset neck pain. Compared with patients initially seen by physician providers, patients treated initially by chiropractors or therapists received fewer and less costly imaging services and were less likely to receive invasive therapeutic interventions during follow-up.

Item #2 Our second and last one this week is called “Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study” by Trager et al and published in BMC Musculoskeletal Disorders on January 10, 2024. Kabam! That’s a hot one! Trager, R.J., Gliedt, J.A., Labak, C.M. et al. Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study. BMC Musculoskelet Disord 25, 46 (2024). https://doi.org/10.1186/s12891-024-07166-x

Why They Did It 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 lumbosacral radiculopathy 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.

How They Did It They searched TriNetX, Inc. for adults aged  ≥ 18 years with lumbosacral radiculopathy and lumbar discectomy  ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. They divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. They 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.

What They Found Following propensity matching there were 378 patients per cohort with a mean age of 61 years. Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort, yielding an risk ratios of 0.55. In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit.

Wrap It Up This study found that adults experiencing lumbosacral radiculopathy at least one year after lumbar discectomy who received spinal manipulative therapy were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT. While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance. We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture.

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

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