Chiropractic Vs. Microdiscectomy

Manipulation or microdiskectomy for sciatica?
A Prospective Randomized Clinical Study Review

Sciatica refers to pain, weakness, numbness, or tingling in the leg with or without lower back pain.  It is caused by injury to or pressure on the sciatic nerve, most often as a result of a herniated or protruding disc in the lower back.

The sciatic nerve is composed of the five nerves arising from the last two lumbar nerves to the top three sacral nerves, L4-L5-S1-S2-S3, which join to form the sciatic nerve which is the biggest nerve in the body.

Symptoms of Sciatica include:
Weakness when bending the knee.
Difficulty bending the foot inward or down.
Difficulty walking on your toes.
Difficulty bending forward or backward.
Abnormal or weak reflexes.
Loss of sensation or numbness.
Pain when lifting the leg straight up when you're lying on the exam table.
Treatments for Sciatica include:
chiropractic care and rehabilitation
physical therapy
acupuncture
over-the-counter pain medication and anti-inflammatories
prescription pain medication and oral steroids
epidurals
surgeries such as micro-discectomies, disc replacements, and spinal fusion

A 2010 study looked at the difference between chiropractic (spinal manipulation) and microdiscectomy for patients with sciatica as a result of lumbar disc herniations (LDH). The study looked at 40 qualifying patients with symptoms of unilateral lumbar radiculopathy secondary to LDH at L3-4, L4-5, or L5-S1 who had failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture. Participants were randomized to either surgical microdiscectomy or standardized chiropractic spinal manipulation.

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 outcomes. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted."

This study shows the efficacy of chiropractic manipulation for the management of disc herniations/protrusions in patients with lower back pain and radicular pain (sciatica). It is prudent to always try conservative care before surgery.

Patients often as me if I recommend surgeries, as many think that I am "anti-surgery" which I am not. The answer is yes, when necessary I will refer out for a surgical consultation. In the past year, I recommended microdiscetomies (microdiskectomies) to at least two of our patients who had significant disc herniations and who either had failed care or had not progressed as much as I would have liked them to progress. In the right patient, and with the right surgeon, surgeries are amazing.  For spine surgeries, I refer out to Dr. Hooman Melamed, The Spine Pro. I met Dr. Melamed years ago, and have referred many patients to him. I find his approach to be detailed, honest, and conservative. He's not a surgeon who's going to do surgery unless he truly thinks he'll be able to help you.  If you or a loved one thinks that they need spinal surgery, I highly recommend you get his opinion on the matter.

If you have any questions regarding care for disc injuries, sciatica, or other spine-related conditions, please don't hesitate to contact us.

Dr. Eric.