By: 6 March 2014

Researchers led by Dr Cynthia Peterson at Orthopaedic University Hospital Balgrist in Zürich, Switzerland, studied 50 patients with neck pain that extended into the arm. Testing displayed nerve root involvement, that was confirmed by MRIs showing a disk herniation in the neck. A course of chiropractic care was begun consisting of high-velocity, low-amplitude spinal manipulations. The patient’s pain intensity was charted while under care. After two weeks of care, 55.3% reported that they were improved (feeling either “better” or “much better”), 68.9% were improved at four weeks, and 85.7% were improved at 12 weeks. Among the group that had chronic disk-related pain, 76.2% reported improvement at 12 weeks.

As reported by PR Web, the results, titled “Outcomes from magnetic resonance imaging–confirmed symptomatic cervical disk herniation patients treated with high-velocity, low-amplitude spinal manipulative therapy: A prospective cohort study with three-month follow-up” were published in the October 2013 issue of the Journal of Manipulative and Physiological Therapeutics.

In May 2013, another research team also led by Dr Cynthia Peterson had published a similar study related to low back disk protrusions in the Journal of Manipulative and Physiological Therapeutics. Titled “Symptomatic magnetic resonance imaging–confirmed lumbar disk herniation patients: A comparative effectiveness prospective observational study of two age- and sex-matched cohorts treated with either high-velocity, low-amplitude spinal manipulative therapy or imaging-guided lumbar nerve root injections”, it compared patient results of chiropractic spinal manipulation to the commonly used nerve root injections in treating the symptoms related to low back disk protrusions. MRI confirmed that 102 patients had low back disk protrusions, which were divided into two age- and sex-matched groups, receiving either spinal manipulation or nerve root injections. Pain intensity was rated before each course of treatment, and again one month later. Improvement (feeling “better” or “much better”) was reported by 76.5% of those receiving chiropractic care, and by 62.7% of those receiving the nerve root injections. Average cost of treatment was £340 for the chiropractic care and £445 for the injections.

Realising the high costs and failure rates of spinal surgery, the University of Pittsburgh Medical Center (UPMC) Health Plan searched for ways to increase success and minimise the costs of spinal care. As of January 1, 2012, UPMC implemented a comprehensive clinical initiative focused on the treatment of chronic low back pain. While surgical emergencies would still be addressed immediately, all other lower back surgeries would require prior authorisation to determine if surgery was medically necessary. Quoting their policy:

“To be considered for surgery, patients with chronic low back pain must have:

  • Tried and failed a three-month course of conservative management, which includes physical therapy, chiropractic therapy, and medication.
  • Completed UPMC Health Plan’s Low Back Pain Health Coaching Program.

“This policy was developed using evidence-based literature and professional society guidelines, as well as the input of external medical professionals with expertise in the area.”