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Chiropractic Research Review

Disc-Related Low Back Pain: Conservative Management vs. Surgical Referral

With low back pain being the burden that it is to both patients and the health care system, patients and health care practitioners regularly must decide if surgery or more conservative management is the best option.

This review of the literature distills and synthesizes previously published research and provides readers with specific information regarding the clinical diagnosis of intervertebral disc-related low back pain and referral of patients for surgery.

The investigators examined a wide range of articles on lumbar intervertebral disc problems. The article lists various causes of low back pain, noting what findings in patient histories, physical examinations, and diagnostic imaging represent "red flags" that indicate the need for surgical intervention.

The investigators listed several conclusions, including the caution that:

Patients should be screened for red flags (bowel or bladder symptoms, fever, history of cancer, unexplained weight loss, urinary tract infection, intravenous drug use, saddle anesthesia, or prolonged use of corticosteroids) to determine whether they are candidates for conservative chiropractic treatment.... Conservative treatment should be the first line of treatment in patients without absolute signs for surgical intervention (patients with a cauda equina syndrome, in the presence of severe motor deficits, and in patients with intractable pain.

The authors also conclude:

Of the available conservative treatments, chiropractic management has been shown through multiple studies to be safe, clinically effective, cost-effective, and to provide a high degree of patient satisfaction. As a result, in patients with discogenic or radicular pain syndromes for whom the surgical indications are not absolute, a minimum of 2 or 3 months of chiropractic management is indicated.

Troyanovich SJ, Harrison DD, Harrison DE. Low back pain and the lumbar intervertebral disk: Clinical consideration for the doctor of chiropractic. Journal of Manipulative and Physiological Therapeutics, Feb. 1999;22(2), pp96-104.
Reprints: Tel: (800) 325-4177, ext 4350; Fax: (314) 432-1380

Chiropractic Research Review

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