Document Detail


Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.
MedLine Citation:
PMID:  21036279     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
Gordon McMorland; Esther Suter; Steve Casha; Stephan J du Plessis; R John Hurlbert
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of manipulative and physiological therapeutics     Volume:  33     ISSN:  1532-6586     ISO Abbreviation:  J Manipulative Physiol Ther     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-11-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7807107     Medline TA:  J Manipulative Physiol Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  576-84     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Affiliation:
Chiropractor, National Spine Care, Calgary, Alberta, Canada. gmcmorland@nationalspinecare.com
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