Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 194: Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic Today we’re going to talk about how lumbar fusion compares to no surgery, we’ll talk about a 30 year study on discs, and we’ll talk about PT vs. Chiro But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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You have found yourself smack dab in the middle of Episode #194 Now if you missed last week’s episode , we talked about patellofemoral pain, sleep for pain, and physical disuse. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. OOOWEEEE…..If you’ve been listening, you know I’ve been goind through my second fellowship program. This second one is the Forensics fellowship. Several hours are taken on ChiroCredit. There’s a 20 hour course on the AMA Guides on Impairment. And there’s a 20 live course I’ll be doing to wrap this dude up. It’s in Chicago in October. Then I’m done. Then, I can turn my full attention to making our new Nurse Practitioner famous locally, making sure our Parker intern is set up for success, and getting life back to some sense of normal. I got the COVID booster shot last week and am headed to Washington DC for the Labor Day weekend. This will probably air just after I get back so updates on the scene in DC on the next episode. Hopefully the covid resurgence hasn’t made the experience a soup sandwich. We shall see. I was 8 months out from when I got the vaccine. The booster came from a nurse practitioner friend of mine. The first shot I got back in December……I felt nothing at all. The second shot 23 days after that, my arm got sore. That’s it. Nothing else at all. This booster shot, my arm got sore as expected. I got it on a Thursday afternoon. She brought it over here to my clinic and gave it to us. Because she’s super sweet and more than awesome. I went to work on Friday. I had almost 40 patients between 8 am and 1 pm and, while I didn’t necessarily struggle, I didn’t love life that day. I was tired. I really wanted to be in bed pretty much. I didn’t feel absolutely awful or anyhting like that. I just didn’t feel particularly good and didn’t really want to be here in the clinic, answering the same questions we always answer, and acting like I felt great and was a happy happy dude when all I really wanted was to just be in bed taking a nap. Then I did go home and take a nap after work. I slept for a couple of hours and woke up feeling much better. Then I woke up the next day and felt great again. No issues. All back to normal. People act like we are sheeple if we get it. Like we are the experiment. Maybe we are. I don’t give a damn. I have a thriving, successful practice with no partner or associate to fill the gap if I get sick and have to stay home. First of all, I like feeling good. I don’t want to be sick. If I can do something that the data shows clearly prevents the virus and/or severe illness from the virus, I’m going to do it. When your clinic bills what mine bills each month, and you don’t care at all about losing that income for 2-4 weeks…..maybe a lot more than that…..then you can call me names. You can call me an experiment. For me, I’m making smart business decisions. Not to mention the fact that after millions and millions of vaccinations globally with very few issues, I’m a hell of a lot more concerned about a proven killing and/or long-term debilitating virus like COVID than I am the vaccine. So, my opinions and what’s right for me may not be right for you annd that’s OK. But I’ll be damned if anyone is going to act smarter, wiser, or more high and mighty than I because I got a freaking vaccine. Those that behave that way can straight up stick it in your ear or whatever other place you can think of. On the other hand, if you got the vaccine, don’t be a jackhole if someone you know doesn’t want it. It’s new. People are scared of it. They’ve been misled in many situations. They’ve been misdirected on social media. It is what it is. You do you. Let’s all do us and realize we share this space. I’d a lot rather see disagreement with an undercurrent of love instead of disagreement with a smoggy fog of hate and disdain. It’s 2021. Let’s all grow up and evolve. Item #1 This first one this week is called, “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis” by Xu et. al. (Xu W 2021) and published in World Neurosurgery in February of 2021….hot mama, stand back. Why They Did It They wanted to evaluate the efficacy and safety of lumbar fusion versus nonoperative care for the treatment of chronic low back pain associated with degenerative disk disease. How They Did It

• A comprehensive search for papers was done in PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure up to June 30, 2020.
• The main outcomes including clinical results, complications, and all-cause additional surgeries were presented in the form of short- and long-term follow-up results.
• Six prospective studies involving 159 patients for short-term follow-up and 675 for long-term follow-up were included

What They Found The 2 interventions exhibited little difference in regard to short- and long-term Oswestry Disability Index and visual analog scale scores for back and leg pain, except that lumbar fusion might bring about lower additional surgery rate, and higher complication rate in the long term. Wrap It Up The present meta-analysis determined that fusion surgery was no better than nonoperative treatment in terms of the pain and disability outcomes at either short- or long-term follow-up. It is necessary for clinicians to weigh the risk of complications associated with fusion surgery against additional surgeries after nonoperative treatment. Item #2 This second one is called, “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi (Sääksjärvi S 2020) and published in Spine Journal in 2020. It’s steamy….but not that hot anymore. Why They Did It The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up. How They Did It

• In an earlier study, 75 patients aged 20 years with LBP had their lumbar spine examined by MRI.
• At a follow-up of 30 years, the subjects were contacted; 35 of 69 filled a pain and disability questionnaire, and 26 of 35 were also reexamined clinically and by MRI.
• The images were evaluated for decreased signal intensity and other degenerative changes.
• Association between decreased signal intensity of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed
• Association between decreased baseline signal intensity and pain/disability scores from the questionnaire was analyzed

What They Found

• The total number of lumbar discs with decreased signal intesity increased from 23 of 130 (18%) to 92 of 130 (71%)
• Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs
• Discs that had even slightly decreased signal intensity at baseline were more likely to have severely decreased signal intensity at follow-up, compared to healthy discs
• The best of the best news, as you may have guessed if you’ve listened to this podcast for any amount of time, Severity of DD at baseline did not have a significant association with current pain or disability.

Wrap It Up In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms. Hallelujah. Item #3 This last one is called, “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation” by Nima Khodarkarami ´(Khodakarami N 2020) and published in Healthcare journal in 2020. Why They Did It Given that there are costs and benefits with either PT or Chiropractic for the treatment of low back pain, the remaining question is in a short period of time which of these treatments is optimal? A decision tree analytic model was used for estimating the economic outcomes. The findings showed that the total average cost in the chiropractic group was $48.56 lower than the PT group. The findings also showed that the daily adjusted life years (DALY) in the chiropractic group was 0.0043 higher than the PT group. Chiropractic care was shown to be a cost-effective alternative compared with PT for adults with at least three weeks of LBP over six months. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website https://www.chiropracticforward.com Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography Khodakarami N (2020). “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation.” Healthcare 8(1): 44. Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347. Xu W, R. B., Luo W, Li Z, Gu R, (2021). “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis.” World Neurosurg 146: 298-306.

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