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Abstract
Objectives Chiropractic spinal manipulative therapy (CSMT) and lumbar discectomy are both used for lumbar disc herniation (LDH) and lumbosacral radiculopathy (LSR); however, limited research has examined the relationship between these therapies. We hypothesised that adults receiving CSMT for newly diagnosed LDH or LSR would have reduced odds of lumbar discectomy over 1-year and 2-year follow-up compared with those receiving other care.
Design Retrospective cohort study.
Setting 101 million patient US health records network (TriNetX), queried on 24 October 2022, yielding data from 2012 query.
Participants Adults age 18–49 with newly diagnosed LDH/LSR (first date of diagnosis) were included. Exclusions were prior lumbar surgery, absolute indications for surgery, trauma, spondylolisthesis and scoliosis. Propensity score matching controlled for variables associated with the likelihood of discectomy (eg, demographics, medications).
Interventions Patients were divided into cohorts according to receipt of CSMT.
Primary and secondary outcome measures ORs for lumbar discectomy; calculated by dividing odds in the CSMT cohort by odds in the cohort receiving other care.
Results After matching, there were 5785 patients per cohort (mean age 36.9±8.2). The ORs (95% CI) for discectomy were significantly reduced in the CSMT cohort compared with the cohort receiving other care over 1-year (0.69 (0.52 to 0.90), p=0.006) and 2-year follow-up (0.77 (0.60 to 0.99), p=0.040). E-value sensitivity analysis estimated the strength in terms of risk ratio an unmeasured confounding variable would need to account for study results, yielding point estimates for each follow-up (1 year: 2.26; 2 years: 1.92), which no variables in the literature reached.
Conclusions Our findings suggest receiving CSMT compared with other care for newly diagnosed LDH/LSR is associated with significantly reduced odds of discectomy over 2-year follow-up. Given socioeconomic variables were unavailable and an observational design precludes inferring causality, the efficacy of CSMT for LDH/LSR should be examined via randomised controlled trial to eliminate residual confounding.
- COMPLEMENTARY MEDICINE
- REHABILITATION MEDICINE
- SURGERY
Data availability statement
Data may be obtained from a third party and are not publicly available. We are unable to make the data used in this study publicly available. This data was obtained via a data use agreement with the TriNetX network that does not allow release or sharing of this data. Those interested in accessing this network may contact TriNetX (https://www.trinetx.com/).
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data may be obtained from a third party and are not publicly available. We are unable to make the data used in this study publicly available. This data was obtained via a data use agreement with the TriNetX network that does not allow release or sharing of this data. Those interested in accessing this network may contact TriNetX (https://www.trinetx.com/).
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Footnotes
Contributors RJT, CJD, RMC, JAP and JAD conceived of and designed the study. RMC and JAP were responsible for data collection and management of the study software and database. RJT, CD, JAP and JAD were responsible for data analysis and interpretation. JAD provided supervision and mentorship. RJT drafted the manuscript, while all authors critically revised and approved the final manuscript. RJT was the guarantor of the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The views expressed are those of the authors and do not necessarily reflect the official policy or position of the US Department of Veterans Affairs or the US Government.
Competing interests RJT reports he has received book royalties as the author of two texts on the topic of sciatica.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.