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

Abstract

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.

Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA

“…Serious pathology causing LBP was excluded via ICD-10 codes used by previous studies for this reason: cauda equina syndrome, infection, fracture or malignancy. 13 14 57 Previous lumbar surgery (postlaminectomy syndrome and arthrodesis status) was excluded which can represent a relative contraindication to CSMT, 58 while structural deformities (spondylolisthesis and scoliosis) were excluded which can increase the odds of lumbar surgery. 59 Absolute contraindications to BZDs were excluded, which could reduce the odds of BZD prescription: closed-angle glaucoma, 21 chronic obstructive pulmonary disease, 21 myasthenia gravis, 21 28 Parkinson's disease, 21 porphyria 21 and pregnant or breastfeeding women 21 (ICD-10: O00-O9A).…”

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

“…However, limited evidence suggests that CSMT can be safely administered in this patient population [ 6 ]. In addition, while there is limited understanding of the types of CSMT approaches used in PSPS-2 [ 7 ], there is some evidence that chiropractors modify their approach for patients with more complex surgeries, such as fusions [ 20 ]. In one survey, chiropractors reported often avoiding CSMT in the region of previous lumbar fusion [ 20 ].…”

“…The chiropractic examination for patients with PSPS-2 includes taking a medical history and performing a physical examination [ 20 ]. This includes conducting orthopedic and neurologic assessments and reviewing available previous imaging [ 6 , 21 ].…”

Clinical decision-making for spinal manipulation for persistent spinal pain following lumbar surgery: a protocol for a systematic review and meta-analysis of individual participant data

“…32 One survey of chiropractors in a large integrative healthcare organisation found less than half of respondents ‘frequently’ or ‘sometimes’ used lumbar HVLA-SMT in patients with prior lumbar fusion. 36 …”

“…32 One survey of chiropractors in a large integrative healthcare organisation found less than half of respondents 'frequently' or 'sometimes' used lumbar HVLA-SMT in patients with prior lumbar fusion. 36 It is less clear how laminectomies or discectomies influence SMT application, as these surgeries preserve segmental mobility. In one study, 76% of members of a small interdisciplinary panel rated SMT as 'appropriate' for patients with previous laminectomy.…”