Is surgery better than exercises for low back pain?

Chiropractic treatment is only one method of treating back pain. Whilst chiropractic treatment has a good success rate for most patients with back pain there are other treatment methods available and surgery is an option in the most extreme cases. A recent study published this month (well a few months ago as I’m updating the blog) in the British Medical Journal looked at whether surgery with disc prosthesis (disc replacement) was more effective than rehabilitation in patients with low back pain and disc degeneration.

Is surgery better than exercises?

At 2 year follow up patients improved more after surgery than rehabilitation but both groups improved overall. The improvement following surgery over rehabilitation was not deemed significant enough in clinical terms. The study concluded that the risks associated with low back surgery should be carefully considered given that rehabilitation worked seemingly almost as well for low back pain.

Rehabilitation and chiropractic treatment

Chiropractors do apply manual therapy techniques with patients but a lot of what we do also includes both rehabilitation and advice to patients on how to manage their back pain and the rehabilitation methods in this study have a lot in common with a visit to see a chiropractor. In this study, patients in the rehabilitation group took part in a variety of physical exercises including training of the abdominal muscles and lumbar multifidi muscles. They also received training on the origins of back pain and were taught coping strategies for getting back to everyday activities. In total they received about 60 hours of outpatient care over three to 5 weeks. There was significant improvement in the rehabilitation group without the risks of surgery! I believe surgery has its place in the management and treatment of back pain but this article is really important in reminding us clinicians to evaluate all the options.

In what cases is surgery appropriate?

As a chiropractor I favour a conservative approach to treating back pain. In the vast majority of cases, patients respond very well to a course of chiropractic treatment even in cases of severe back pain. I have even had cases whereby patients are scheduled appointments with neurosurgeons and following a course of treatment feel they do not need to continue down the surgical route. However it is also true in some cases that patients do not respond and I will then discuss alternative options with the patient. Should this be the case then I will write to a patient’s GP to discuss referral to an appropriate specialist and in some cases this ends up being a referral to a spinal surgeon.

Read the article for yourself

http://www.bmj.com/content/342/bmj.d2786.full.pdf?sid=a871cd1a-1d90-4254-87a6-6164cd376323

If you would like to discuss any aspect of chiropractic care for low back pain or any of the points raised in this article then do get in contact.

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