CF 198: MRI’s and Clinic Presentation & Surgery vs. Conservative Care For Discs Today we’re going to talk about surgery vs. conservative treatment for discs and we’ll talk about MRI findings and clinical pain. 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.
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You have found yourself smack dab in the middle of Episode #198
Now if you missed last week’s episode , we talked about Extruded Discs – Surgery or No Surgery? Make sure you don’t miss that info. Keep up with the class.On the personal end of things….. Well, we went with ReviewWave and I have to say it’s overall been a very positive experience. Except for this one thing. Today, we showed up for work and we have it set to where new patients can pick their schedule and make the appointment themselves. Within certain parameters, of course. Well. Something’s wonky because we showed up at work and, instead of the 6 or 7 new patients we expected today, we now have 10 new patients and 4 re-exams on top of our regular load of established patients. As you can imagine, this presents a certain set of difficulties. Especially when my exam takes 20 minutes minimum and more typically takes about 30-40 minutes per new patients. So, we’re forced to step on the gas a touch. We’ll get through it and we’ll do a good job but, being too busy is as bad as not being busy enough in some ways. Patients like to know they’re going to a provider that a lot of other folks go to and find value in. But, when it looks like you’re running them through like cattle and your one on one time is 30-45 seconds rather than a couple of minutes or more….they notice it and I don’t care what the vitalistic philosophy wonk gurus in the profession try to convince you, patients don’t like that. They feel it and sense it and they don’t like it. I don’t like it. I don’t like people waiting on me. I don’t like making a bad first impression. I don’t like to be rushed any more than I normally am. More than anything, I don’t want to fall into quantity over quality. I always want quality here. And never forsake it in the search for quantity. That’ll get us nowhere that we want to go. So, this part of the show will be short, we will survive and do a good job regardless of time constraints, and we have a call scheduled with ReviewWave to remedy the issue. When you get too busy to fit them in, create a waiting list, hire help, or raise your pricing to thin the herd. Just a little tip from your Ol’ Uncle Jeffro. Let’s dive in Item #1 The first one is called “Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study” by Gugliotta et. al.(Gugliotta M 2016)and published in BMJ Open, that is the British Medical Journal for the peasants in the crowd. It’s a joke! Anyway, it was published in December of 2016 and it goes a lil sumpin like dis…. Why They Did It We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. How They Did It
It was a prospective cohort study of a routine clinical practice registry consisting of 370 patients.
Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life.
Primary outcomes were back pain at 6 and 12 weeks.
Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks.
What They Found
Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy, were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks and reported less physical function disability at 52 weeks.
The other assessments showed minimal between-group differences with CIs, including the null effect.
Wrap It Up Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up.
So, bad for conservative interventions in the short term. Good in the long term. When they spread it out and look long term, there’s minimal difference. So, why risk it in the first place. The rate that low back surgeries must be re-done is too high to risk it. They estimate that around 40% of back surgeries fail. Yeah, I’m good as long as I don’t have cauda equine or progressive neurological deficits. You keep your full dose of surgery. I’ll have none on this day! So, long-term, minimal difference,…..well then we’re going with no surgery any time it’s appropriate and makes sense. CHIROUP ADVERTISEMENT Item #2 Alright, the last paper we have today is called, “Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-Based Cohort Study” by Kasch et. al. (Kasch R 2021) and published in Spine Journal.Why They Did It The authors wanted to examine associations between common lumbar degenerative changes observed on MRI and present or future low back pain.How They Did It
Participants from a population-based cohort study were imaged at study entry,
LBP status measured at baseline and 6-year follow-up.
MRI scans were reported for the presence of a range of MRI findings.
LBP status was measured on a 0-10 scale.
What They Found
MRI findings were present in persons with and without back pain at baseline.
Higher proportions were found in older age groups.
76.4% of participants had a least one MRI finding and 8.3% had 5 or more different MRI findings.
Most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings
In the longitudinal analyses we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain.
Compared to zero MRI findings, having multiple MRI findings (≥5) was associated with mildly greater pain-severity at baseline and greater increase in pain-severity over 6 years in those pain free at baseline, but not in those with baseline pain
Wrap It Up Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0-10 pain scale
Meaning, quit catastrophizing MRI findings. Quit telling 40 year olds they have the backs of 85 year olds. Quit pushing them into the chronic pain pit because you don’t know schiza from shinola and you’re too damn lazy to take the time and energy to get some smarts beyond what you learned in chiropractic college. Slap pow pop kazow!!
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
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Bibliography Gugliotta M, d. C. B., Dabis E, Theiler R, Jüni P, Reichenbach S, Landolt H, Hasler P. (2016). “Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.” BMJ Open 6(12).
Kasch R, T. J., Hancock MJ, Maher CG, Otto M, Nell C, Reichwein N, Bülow R, Chenot JF, Hofer A, Wassilew G, Schmidt CO (2021). “Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-Based Cohort Study.” Spine (Phila Pa 1976).
