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Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.

Gordon McMorland1, Esther Suter, Steve Casha

  • 1Chiropractor, National Spine Care, Calgary, Alberta, Canada. gmcmorland@nationalspinecare.com

Journal of Manipulative and Physiological Therapeutics
|November 2, 2010
PubMed
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For sciatica due to lumbar disk herniation (LDH) unresponsive to conservative care, spinal manipulation offers similar outcomes to microdiskectomy. Patients not improving with manipulation may still benefit from subsequent surgery.

Area of Science:

  • Neurosurgery
  • Orthopedics
  • Physical Medicine and Rehabilitation

Background:

  • Sciatica resulting from lumbar disk herniation (LDH) is a common cause of debilitating low back pain.
  • Non-operative management often fails, leading to consideration of surgical interventions like microdiskectomy.
  • Spinal manipulation is a conservative treatment option for various spinal conditions.

Purpose of the Study:

  • To compare the clinical effectiveness of spinal manipulation versus microdiskectomy for sciatica caused by LDH.
  • To evaluate treatment outcomes in patients who failed at least 3 months of non-operative management.

Main Methods:

  • A randomized controlled trial involving 40 patients with symptomatic LDH.
  • Participants were assigned to either microdiskectomy or standardized chiropractic spinal manipulation.

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  • Crossover to the alternative treatment was permitted after 3 months if initial treatment was unsuccessful.

    • Main Results:

    • Both treatment groups showed significant improvement from baseline across all outcome measures.
    • No significant difference in outcomes was observed between spinal manipulation and microdiskectomy at 1-year follow-up.
    • Patients who switched from spinal manipulation to surgery experienced significant improvement.

    Conclusions:

    • Spinal manipulation provides comparable clinical efficacy to microdiskectomy for selected patients with sciatica due to LDH.
    • Approximately 60% of patients benefited from spinal manipulation to a degree similar to surgery.
    • Subsequent surgical intervention is highly effective for patients who do not respond to spinal manipulation.