According to the Mayo Clinic, “back surgery is needed in only a small percentage of cases. Most back problems can be taken care of with nonsurgical treatments, such as anti-inflammatory medication, ice, heat, gentle massage and physical therapy.” Accurate on face value, but missing an important piece of the puzzle. Yes, while back pain is rampant, surgery is rarely required; even the Mayo Clinic admits that while “back pain is extremely common … surgery often fails to relieve it.” However, chiropractic is glaringly absent from the nonsurgical recommendations, despite ample research evidence supporting chiropractic care for back pain and increasing reliance on chiropractic as a first-line treatment option.
So, what determines whether a patient undergoes spinal surgery? A recent study attempted to answer that very question and came up with several predictive variables, perhaps the most interesting of which is the type of health care provider – namely a surgeon or a doctor of chiropractic – the back pain patient sees first. The study authors, who note that “there is little evidence spine surgery is associated with improved population outcomes, yet surgery rates have increased dramatically since the 1990s,” found that Washington state workers with an occupational back injury who visited a surgeon (orthopedic, neuro or general) first were significantly more likely to receive spine surgery within three years (42.7 percent of workers) than workers whose first visit was to a doctor of chiropractic (only 1.5 percent of workers). This association held true even when controlling for injury severity and other measures.
Of the 174 workers (9.2 percent of the subject population) who had a surgery during the three-year time frame, the vast majority were decompression procedures (78.7 percent), with 3.4 percent undergoing fusion without decompression and 17.8 percent undergoing both on the same day.
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