In a recent study from University Hospitals (UH) Connor Whole Health, researchers found that patients who have recurrent or ongoing pain after lumbar spine surgery may seek out a therapy called spinal manipulation, which targets the joints of the spine. The study, published in Chiropractic & Manual Therapies, found that those providing spinal manipulation for these patients typically use gentle techniques.
Spinal manipulation is a type of manual therapy (i.e., hands-on treatment) directed to the spinal joints, and can involve a variety of techniques. The authors note that while there is plenty of evidence supporting this therapy for treatment of low back pain, there is little evidence for its use in patients with previous low back surgery. The authors were interested in how spinal manipulation was used in these patients.
Following their protocol originally published in BMJ Open, the authors summarized all available published cases describing the use of spinal manipulation in patients with previous low back surgery, using a technique called systematic review and meta-analysis of individual participant data. In this method, they compiled data from 71 different publications, and requested data from several authors around the world.
In total, the authors summarized data from more than 100 patients with previous low back surgery receiving spinal manipulation. These patients were on average 50 years or older, and the most common type of surgery was a laminectomy (40% of patients). The authors reported that most cases of spinal manipulation to the lower back did not involve a thrust or impulse, or put another way, were done using a potentially gentler method.
“Until now, we did not have a great understanding of which patients with surgery were receiving spinal manipulation, and what this looked like clinically. With this research we now know that spinal manipulation is usually done in a gentle manner for those patients having a previous spine surgery,” said Dr. Robert Trager of Connor Whole Health, University Hospitals of Cleveland, the lead author of the study.
The authors caution that their findings should not be interpreted as a clinical guideline for these patients, and note that further research is needed to examine the safety and efficacy of spinal manipulation for patients with previous low back surgery.
Robert J. Trager et al, Clinician approaches to spinal manipulation for persistent spinal pain after lumbar surgery: systematic review and meta-analysis of individual patient data, Chiropractic & Manual Therapies (2023). DOI: 10.1186/s12998-023-00481-5
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