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Several major studies have been performed over the past decade comparing the short term and long term benefits of different types of care for those suffering from back pain with radiating pain into leg from a herniated disc. What has been found is that patients who undergo conservative care recover equally well to those who have had surgery. It was once thought that if a patient was suffering from a herniated disc that surgery was needed and that waiting could be harmful. Not only does this study show that waiting is almost as good as surgery, but most importantly, there is no risk of significant harm in waiting, using non-surgical care instead, even in cases of severe sciatica.
With 1.2 million spinal surgeries in the U.S. each year, double the rate of those other countries, it is time that less invasive alternatives are more fully utilized. A recent article in the prestigious journal, Spine, reports that Epidural steroid injection is moderately effective for short-term (but not long term) symptom relief. Prolotherapy, facet joint injection, intradiscal steroid injection, and percutaneous intradiscal radiofrequency thermocoagulation are not effective. Surgery for leg pain and herniated discs give short-term benefits that decline long-term compared with non-surgical therapy. Surgery for symptomatic spinal stenosis gives short-term benefits that decline long-term compared with non-surgical therapy.
Guidelines sponsored by the American Pain Society and the American College of Physicians recommend spinal manipulation as an effective treatment option for low back pain. Surgical outcomes for stenosis are nearly equal to that of non-surgical outcomes (53% vs. 50% respectively), yet the spine is still intact after non-surgical, non-operative care. Surgical outcomes for disc herniations causing leg pain (sciatica) are nearly equal to those of conservative care (69% vs 61% respectively), yet no surgical intervention opened the spine. Four to 6 weeks of non-operative, conservative treatment is recommended prior to imaging studies and surgery. The American Academy of Orthopaedic Surgeons states that “acupuncture or chiropractic manipulation can also be attempted” prior to surgery for stenosis. Lumbar spinal stenosis patients improved by 76% and their related disability improved by 73% treated with Cox® Technic and/or neural mobilization. (12)
Some years ago a large study showed that chiropractic care was effective for sciatica cases where regular medical care like physiotherapy and drugs had not helped. Some 3,136 persons with low back pain and sciatic pain who had no positive results with standard medical care were given chiropractic care and over half had excellent results with no relapses and another 34 % improved but had relapses that then responded well to additional care. Only 15.2% had no significant improvement.
The most important finding of this study was that there is no harm in trying conservative chiropractic care first. Chiropractic care is relatively inexpensive compared to surgery, has a fraction of the risk of most any surgery, and is highly effective in relieving the suffering of back and leg pain.