While treatment guidelines recommend exhausting conservative approaches—such as chiropractic care—before considering surgery, this doesn’t always happen. In fact, hundreds of thousands of surgeries for low back-related conditions are performed each year in the United States alone, and it’s estimated that—depending on the criteria used—between 4% and 50% of patients may continue to report ongoing low back pain and other symptoms. In the past, this condition was known as failed back surgery syndrome but has since been reframed as persistent spinal pain syndrome type-2 (PSPS-2). Can chiropractic care benefit the PSPS-2 patient?
In April 2023, researchers published a study that looked at a decade of data concerning 81,291 patients who had received chiropractic spinal manipulation and were treated at academic health centers in the United States. The data show that 10.8% of these patients had a history of at least one prior spine surgery. Further analysis revealed that these patients were more likely to be older with multiple medication prescriptions and a history of spinal injections.
A study published the previous year looked at the charts of 6,589 low back pain patients from twenty chiropractic clinics. Just over four-in-five (81%) of patients with a previous history of back surgery had undergone a laminectomy with discectomy, and fusion procedures accounted for the remainder. These patients generally received a multimodal treatment approach that included spinal manipulation (100%), drop technique (81%), passive modalities (65%), soft tissue manipulation (13%), flexion distraction (13%), and mechanical traction (13%). At the conclusion of treatment, all patients reported clinically important improvements in pain and disability, and 48% continued to report such improvements a year later. Upon further analysis, the researchers found that characteristics linked to the best long-term outcomes for PSPS-2 patients under chiropractic care include younger age, shorter history of back pain, and higher pain and/or disability levels at the onset of treatment.
The findings from this pair of studies suggest that a significant number of patients who undergo back surgery may continue to experience back pain, and many of these patients seek chiropractic care. The good news is that most (if not all) report clinically significant relief, and up to half may continue to report reduced pain and disability for a year or longer without additional care.
Of course, in a perfect world, your doctor of chiropractic would prefer you seek care for low back pain before considering surgery because, not only is chiropractic a recommended front-line treatment for low back pain, but a 2013 study found that patients who received chiropractic care first were nearly 29 times less likely to eventually have back surgery than those who initially consulted with a surgeon!
