A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice

Daniels, Clinton J.; Wakefield, Pamela J.; Bub, Glenn A.; Toombs, James D.

doi:10.1016/j.jcm.2016.08.007

Cited by 14 publications

(12 citation statements)

References 119 publications

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“…To date there are no published systematic reviews that evaluate chiropractic or spinal manipulation after lumbar fusion [28]. A systematic review of physical therapy and rehabilitation treatments identified good evidence to recommend patient education as a part of pre-and postoperative fusion rehabilitation, moderate evidence to recommend neutral spine control exercise to increase core strengthening as part of operative fusion rehabilitation, and moderate evidence for adding postoperative psychological coping techniques to a rehabilitation program [47].…”

Section: Discussionmentioning

confidence: 99%

“…Several case reports describe clinical improvements with chiropractic care in patients with postsurgical lumbar spine pain [21][22][23][24][25][26][27]. There are no cohort studies or experimental designs reporting on the outcomes of care provided by chiropractors in patients with prior lumbar fusion [28]. A recent VA research agenda from a stateof-the-art research conference on non-pharmacological care of chronic musculoskeletal conditions identified postoperative spine pain as a research priority for manual therapies, including manipulation and massage [29].…”

Section: Introductionmentioning

confidence: 99%

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Management of patients with prior lumbar fusion: a cross-sectional survey of Veterans Affairs chiropractors’ attitudes, beliefs, and practices

et al. 2020

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Background: Little is known about the preferred treatment strategies of chiropractors in managing low back pain patients with prior lumbar fusions. There are several case reports which describe chiropractic care following surgical intervention, but there are no cohort or experimental studies published. Therefore, we sought to examine selfreported management approaches and practice patterns related to the management of patients with prior surgical lumbar fusion, among United States Veterans Affairs (VA) chiropractors. Methods: An electronic survey was administered nationwide to all chiropractors providing clinical care within VA. Questions were informed by a prior survey and piloted on a sample of chiropractors external to VA. Statistical analysis included respondent background information, and quantitative analysis of chiropractic referral patterns and practices. This survey collect information on 1) provider demographics, 2) VA referral patterns, and 3) attitudes, beliefs, practices and interventions utilized by VA chiropractors to manage patients with a history of surgical lumbar fusion. Results: The survey response rate was 46.3% (62/134). The respondents were broadly representative of VA chiropractic providers in age, gender, and years in practice. The majority of respondents (90.3%) reported seeing at least 1 postfusion patient in the past month. The most common therapeutic approaches utilized by VA chiropractors were healthy lifestyle advice (94.9%), pain education (89.8%), exercise prescription (88.1%), stretching (66.1%) and soft tissue manual therapies (62.7%). A relatively smaller proportion described always or frequently incorporating lumbar (16.9%), thoracic (57.6%) or pelvic (39.0%) spinal manipulation. Conclusion: This survey provides preliminary data on VA chiropractic services in the management of patients with prior lumbar fusion. These patients are often seen by VA chiropractors, and our findings support the need for further study to advance understanding of interventions utilized by chiropractors in this patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of patients with prior lumbar fusion: a cross-sectional survey of Veterans Affairs chiropractors’ attitudes, beliefs, and practices

et al. 2020

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“…There was a large body of lower-level studies that were not assessed for quality. This included 1 scoping review [31], 1 narrative review [32], 14 case series [33][34][35][36][37][38][39][40][41][42][43][44][45][46], 23 case reports , and 2 commentaries [70,71]. Ten of the case reports described 53 cases following discectomy, 16 reports described MMT in 143 cases post-laminectomy, 16 reports described MMT care for 67 cases after fusion, 1 report discussed post-surgical treatment in 8 cases after artificial disc replacement, and 1 report discussed care in 3 cases following implantation of spinal cord stimulators.…”

Section: Literature Reviews Case Reports and Commentariesmentioning

confidence: 99%

Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review

Daniels

Cupler

Gliedt

et al. 2021

Complementary Therapies in Clinical Practice

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Background The purpose was to identify, summarize, and rate scholarly literature that describes manipulative and manual therapy following lumbar surgery. Methods The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was registered with PROSPERO. PubMed, Cochrane Database of Systematic Reviews, ICL, CINAHL, and PEDro were searched through July 2019. Articles were screened independently by at least two reviewers for inclusion. Articles included described the practice, utilization, and/or clinical decision making to post surgical intervention with manipulative and/or manual therapies. Data extraction consisted of principal findings, pain and function/disability, patient satisfaction, opioid/medication consumption, and adverse events. Scottish Intercollegiate Guidelines Network critical appraisal checklists were utilized to assess study quality. Results Literature search yielded 1916 articles, 348 duplicates were removed, 109 full-text articles were screened and 50 citations met inclusion criteria. There were 37 case reports/case series, 3 randomized controlled trials, 3 pilot studies, 5 systematic/scoping/narrative reviews, and 2 commentaries. Conclusion The findings of this review may help inform practitioners who utilize manipulative and/or manual therapies regarding levels of evidence for patients with prior lumbar surgery. Following lumbar surgery, the evidence indicated inpatient neural mobilization does not improve outcomes. There is inconclusive evidence to recommend for or against most manual therapies after most surgical interventions.

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“…It has been estimated that as much as 20% to 36% of all cases of failed back surgery may be due to epidural fibrosis [ 22 ]. Nevertheless, for post-fusion lumbar pain there is limited evidence for the safety and efficacy of chiropractic treatment and no guidelines to aid with therapeutic decision-making [ 23 ].…”

Section: The Principle Of Spinal Adhesionsmentioning

confidence: 99%

Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal

2018

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Over a period of decades chiropractors have utilized spinal manipulation under anesthesia (SMUA) to treat chronic back and neck pain. As an advanced form of manual therapy, SMUA is reserved for the patient whose condition has proven refractory to office-based manipulation and other modes of conservative care. Historically, the protocols and guidelines put forth by chiropractic MUA proponents have served as the clinical compass for directing MUA practice. With many authors and MUA advocates having focused primarily on anticipated benefit, the published literature contains no resource dedicated to treatment precautions and contraindications. Also absent from current relevant literature is acknowledgement or guidance on the preliminary evidence that may predict poor clinical outcomes with SMUA. This review considers risk and unfavorable outcomes indicators in therapeutic decision making for spinal manipulation under anesthesia. A new risk classification system is proposed that identifies patient safety and quality of care interests for a procedure that remains without higher-level research evidence. A scale which categorizes risk and outcome potential for SMUA is offered for the chiropractic clinician, which aims to elevate the standard of care and improve patient selection through the incorporation of specific indices from existing medical literature.

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A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice

Cited by 14 publications

References 119 publications

Management of patients with prior lumbar fusion: a cross-sectional survey of Veterans Affairs chiropractors’ attitudes, beliefs, and practices

Management of patients with prior lumbar fusion: a cross-sectional survey of Veterans Affairs chiropractors’ attitudes, beliefs, and practices

Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review

Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal

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