Chiropractic treatment of spinal disk herniations

Neck and back pain stemming from spinal disk herniations is one of the most common as well as costliest conditions in the United States healthcare landscape. Approximately 14% of the population experiences neck pain every year and 85% are expected to encounter back pain sooner or later in their lifetimes. The cost of spinal related pain exceeds $85 a year in the U.S. alone. The treatment usually involves painkillers, anti-inflammatories, and muscle relaxants, and failing that, spinal surgery. However, the low rate of effectiveness doesn’t seem to be justifying the elevated cost.

That poor cost-to-success ratio has not gone unnoticed by the University of Pittsburgh Medical Center (UPMC), whose Health Plan teamed with the University’s School of Medicine in order to find more cost-effective ways to improve spinal care healthcare. For almost a year now, UPMC has enforced a clinical program that emphasizes chronic low back pain treatment. The protocol establishes that surgical emergencies are top priority, but that any other lower back surgery would have to meet several conditions before being authorized. Those conditions are completing UPMC Health Plan’s low back pain health coaching program and, more importantly, unsuccessfully undergoing a three-month course of conservative management, which includes physical therapy, chiropractic therapy, and medication.

This guideline was determined using evidence-based literature, such as that authored by Dr. Cynthia Peterson at Orthopedic University Hospital Balgrist in Zürich, Switzerland. In early 2013 Dr. Peterson published a study on low back disk protrusions, comparing chiropractic spinal manipulation patient results and the nerve root injections frequently used to treat low back disk protrusion symptoms. The intensity of pain of the 102 patients –divided into age and sex-matched groups- was measured before each treatment, and once again one month later. Over 75% of the patients treated with chiropractic care reported feeling better or much better, versus 62% of those who were administered nerve root injections. The cost for chiropractic care was $558.72, while the injections cost $729.61.

Dr. Peterson followed that study with another one involving 50 patients with neck pain that radiated into the arm caused by disk herniation in the neck.  After two weeks of high-velocity, low-amplitude spinal manipulations, 55% of the patients reported improvement, followed by 68% after four weeks, and 85% after 12 weeks. Despite the fact that these studies only confirm the long-standing positive effects of chiropractic care, both cost-wise and time-wise, UPMC is the first leading medical college to mandate that their patients consult a chiropractor as a pre-requisite before surgery. Only time will tell if others join this initiative. 

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