Effectiveness of Multimodal Chiropractic Care Featuring Spinal Manipulation for Persistent Spinal Pain Syndrome Following Lumbar Spine Surgery: Retrospective Chart Review of 31 Adults in Hong Kong

Abstract

Background The term “persistent spinal pain syndrome type 2” (PSPS-2) has been proposed by the International Association for the Study of Pain to replace the term “failed back surgery syndrome”. This retrospective study aimed to evaluate effectiveness of multimodal care featuring chiropractic spinal manipulation (CSMT) in 31 adults in Hong Kong with PSPS-2. Material/Methods We identified new adult patients with PSPS-2 receiving CSMT from 2016 to 2018. Demographic and clinical data and baseline/follow-up numeric pain rating scale (NPRS) and Oswestry Disability Index (ODI) scores were extracted. Multiple linear regression was used to examine posttreatment NPRS and ODI reduction, with clinical variables as covariates. Results Of 6589 patients with low back pain, 31 met criteria (mean age 52.2±13.7 years). Surgeries included laminectomy (81%), discectomy (13%), and fusion (6%). Mean baseline NRPS was 6.6±1.9; ODI was 43.8±15.1%. Patients received CSMT (100%), drop technique (81%), passive modalities (65%), soft tissue manipulation (13%), flexion-distraction (13%), and mechanical traction (13%). Mean posttreatment NPRS was 0.6±1.0; ODI was 2.4±3.3%. All patients had a minimum clinically important difference for NPRS (≥2/10) and ODI (≥30%). One year after treatment, 48% maintained improvement, 42% experienced recurrence; in 10%, follow-up was unavailable. Regression analysis identified younger age, shorter symptom duration, and greater baseline NPRS as predictors of NPRS reduction; and greater baseline ODI as a predictor of ODI reduction (all P <0.05). Conclusions Patients with PSPS-2 improved with multimodal care featuring CSMT, which was more effective in patients with younger age, shorter symptom duration, and higher baseline pain or disability levels.

Improvement of Chronic Neck Pain After Posterior Atlantoaxial Surgical Fusion via Multimodal Chiropractic Care: A Case Report

“…Therefore, we suggest that these treatments should be used cautiously on a case-by-case basis. Certain clinical variables such as patients' age, the length of time since surgery, the presence of neurologic deficits, the type of surgery, the presence of surgical implants, or the number of spinal segments involved in the surgery could be relevant toward influencing a providers' decision to use manual therapy in these patients, or the type of manual therapy used [27][28][29][30].…”

Recognizing Hong Kong Chiropractors’ Sick Leave Authority: Valuing a Conservative Approach to Workers’ Compensation

“…Chiropractors in Hong Kong utilize manual techniques such as spinal manipulation and soft tissue mobilization to address musculoskeletal dysfunction and reduce pain [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. According to a 2013 survey undertaken by the Census and Statistics Department of the Hong Kong Special Administrative Region, more than half (53.6%) of the 33,700 individuals who received chiropractic care had previously tried other forms of treatment.…”

“…[3] Chiropractors in Hong Kong are legally authorized to diagnose and treat musculoskeletal conditions. As conservative spine specialists and primary care practitioners, numerous studies have reported that chiropractors in Hong Kong provide non-invasive care for prevalent neuromusculoskeletal conditions and injuries [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. However, their inability to officially certify patients' incapacity limits the utility of chiropractic services.…”

Optimizing Primary Healthcare in Hong Kong: Strategies for the Successful Integration of Radiology Services

“…Radiology services in primary care can reduce needless referrals to specialists and hospitals and optimize healthcare resource use. Primary healthcare practitioners, including general practitioners, nurses, pharmacists, physiotherapists, and chiropractors, can perform many initial diagnostic examinations with direct access to diagnostic imaging services [ 21 , 22 ]. This technique reduces the number of patients referred to specialists and hospitals for diagnostics, relieving secondary and tertiary care facilities.…”