This study directly compared microdiskectomy surgery against chiropractic spinal manipulation in 40 patients with sciatica from a disc herniation, all of whom had already tried at least three months of conservative treatment without success, following outcomes for one year.
What was studied?
Patients who hadn't improved with conservative care were assigned to a structured course of manipulation, with those who responded compared against those who went straight to surgery, and non-responders having surgery afterwards.
What did they find?
60% of patients who received spinal manipulation improved to a similar degree as those who had surgery, avoiding an operation altogether. The 40% who didn't improve went on to have surgery and benefited from it, with both groups improved at one year.
Why it matters
For patients told surgery is their only remaining option after conservative treatments haven't worked, this is genuinely important evidence that manipulation is a reasonable option to try first, with real potential to avoid surgery.
Why we included it
It shows the value of a stepped approach to care: trying a lower-risk option before an irreversible one, without closing off surgery for those who need it, keeps both possibilities genuinely available.
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What was studied?
Patients who hadn't improved with conservative care were assigned to a structured course of manipulation, with those who responded compared against those who went straight to surgery, and non-responders having surgery afterwards.
What did they find?
60% of patients who received spinal manipulation improved to a similar degree as those who had surgery, avoiding an operation altogether. The 40% who didn't improve went on to have surgery and benefited from it, with both groups improved at one year.
Why it matters
For patients told surgery is their only remaining option after conservative treatments haven't worked, this is genuinely important evidence that manipulation is a reasonable option to try first, with real potential to avoid surgery.
Why we included it
It shows the value of a stepped approach to care: trying a lower-risk option before an irreversible one, without closing off surgery for those who need it, keeps both possibilities genuinely available.