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Spinal manipulation and cervical disc herniation

A recent article published in the Journal of Manipulative and Physiological Therapeutics reports findings of a study evaluating treatment costs, pain reduction, and overall improvement for patients with symptomatic cervical disc herniation (1). In this study, patient databases within a European orthopedic/rheumatology university hospital were searched. Clinical outcomes and cost of care for 52 patients with clinical signs and symptoms consistent with MRI findings treated with cervical nerve root injections were collected. Clinical outcomes and costs were also collected from 52 age and sex matched patients in the chiropractic database who were treated with spinal manipulation (SM). This study design was used to compare cost and clinical outcomes for these 2 types of treatments.

Prospective cohort (or group) studies often measure one type of care against another as it occurs in normally operating clinical settings. These studies are thought to better represent patient responses that could be expected during routine clinical care in other locations. This method is contrasted with randomized clinical trials, which typically exclude more participants to ensure a certain amount of homogeneity. The homogeneity is often necessary to answer specific scientific questions, but it can have the effect of making results somewhat less generalizable to other types of patients. This does not mean randomized controlled trials are not as good, valuable, or robust. In some circumstances a randomized controlled trial is the best way to answer a research question.

Peterson and colleagues reported the average cost for patients receiving SM was similar but slightly less than for those receiving cervical nerve root injection. Both groups reported pain reduction after 3 months with the SM group reporting statistically more pain reduction. Clinically relevant improvement was reported by 86% of patients receiving SM and 49% of those receiving cervical nerve root injection. No adverse events in either cohort were reported.

Reference List
(1) Peterson CK, Pfirrmann CW, Hodler J, Leemann S, Schmid C, Anklin B, et al. Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. J Manipulative Physiol Ther 2016 Mar;39(3):210-7.

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