Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study

Hincapié, Cesar A.; Cassidy, J. David; Côté, Pierre; Rampersaud, Y. Raja; Jadad, Alejandro R.; Tomlinson, George

doi:10.1007/s00586-017-5295-0

Cited by 6 publications

(5 citation statements)

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“…Various complications may develop during treatment sessions for low back and neck pain. Reported complications have included disc herniation, vertebral fracture, and cervical arterial strokes [23][24][25]. It is important to determine the intensity and direction of the force to be applied in order to prevent possible complications.…”

Section: Discussionmentioning

confidence: 99%

Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study

ÖTEN¹

2022

Journal of Surgery and Medicine

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Section: Discussionmentioning

confidence: 99%

Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study

ÖTEN¹

2022

Journal of Surgery and Medicine

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“…In this study, we performed a Bayesian analysis that 1) used prior distributions derived from a belief elicitation study of clinician experts [7] and likelihoods from a population-based self-controlled case series study [8] with varying case de nitions, 2) estimated the posterior distribution of the incidence rate ratio (IRR) for acute LDH with early surgical intervention after chiropractic care versus primary medical care, and 3) investigated how different groups of priors (enthusiastic, neutral, and skeptical) in uenced the posterior distribution for each of the case de nitions.…”

Section: Methodsmentioning

confidence: 99%

“…The prior distributions were obtained by eliciting clinicians' beliefs regarding the risk for acute LDH associated with chiropractic spinal manipulation, between 19 August 2011 and 14 October 2011. Detailed information and results were published previously [7]. Brie y, three groups of clinicians (15 chiropractors, 15 family physicians, and 16 spine surgeons) with experience in treatment of back pain patients, were questioned in an interactive face-to-face interview to elicit their beliefs about incidence estimates of acute surgically managed LDH.…”

Section: Prior Distributions -Clinician Expert Belief Elicitationsmentioning

confidence: 99%

A Bayesian analysis integrating expert beliefs highlighted the value of eliciting informative priors to better understand how new evidence should change what we believe: a use case of chiropractic care and acute lumbar disc herniation with early surgery

DCM,

Fontana,

Tomlinson

et al. 2023

Preprint

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Background A Bayesian approach may be useful in the study of possible treatment-related rare serious adverse events, particularly when there are strongly held opinions in the absence of good quality previous data. We demonstrate the application of a Bayesian analysis by integrating expert opinions with population-based epidemiologic data to investigate the association between chiropractic care and acute lumbar disc herniation (LDH) with early surgery. Methods Experts’ opinions were used to derive probability distributions of the incidence rate ratio (IRR) for acute LDH requiring early surgery associated with chiropractic care. A ‘community of priors’ (enthusiastic, neutral, and skeptical) was built by dividing the experts into three groups according to their perceived mean prior IRR. The likelihood was formed from the results of a population-based epidemiologic study comparing the relative incidence of acute LDH with early surgery after chiropractic care versus primary medical care, with sensitive and specific outcome case definitions and surgery occurring within 8- and 12-week time windows after acute LDH. The robustness of results to the community of priors and specific versus sensitive case definitions was assessed. Results The most enthusiastic 25% of experts had a prior IRR of 0.42 (95% credible interval [CrI], 0.03 to 1.27), while the most skeptical 25% of experts had a prior IRR of 1.66 (95% CrI, 0.55 to 4.25). The Bayesian posterior estimates across priors and outcome definitions ranged from an IRR of 0.39 (95% CrI, 0.21 to 0.68) to an IRR of 1.40 (95% CrI, 0.52 to 2.55). With a sensitive definition of the outcome, the analysis produced results that confirmed prior enthusiasts’ beliefs and that were precise enough to shift prior beliefs of skeptics. With a specific definition of the outcome, the results were not strong enough to overcome prior skepticism. Conclusion A Bayesian analysis integrating expert beliefs highlighted the value of eliciting informative priors to better understand how new evidence ought to update prior existing beliefs. Clinical epidemiologists are encouraged to integrate informative and expert opinions representing the end-user community of priors in Bayesian analyses, particularly when there are strongly held opinions in the absence of definitive scientific evidence.

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“…In addition, there is evidence from randomized clinical trials showing benefit of spinal manipulation for the management of LDH with radiculopathy [26][27][28], yet little is known about the safety of this treatment. To date, no valid epidemiologic assessment of the risk for acute disc herniation following chiropractic treatment is available in the scientific literature [29,30]. The current literature presents case reports and small case series linking lumbar spine manipulation to disc herniation and cauda equina syndrome [31].…”

Section: Introductionmentioning

confidence: 99%

Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study

et al. 2017

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Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.

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Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study

Cited by 6 publications

References 32 publications

Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study

Investigation of postero-anterior mobilization in the lumbar spine: A finite element analysis study

A Bayesian analysis integrating expert beliefs highlighted the value of eliciting informative priors to better understand how new evidence should change what we believe: a use case of chiropractic care and acute lumbar disc herniation with early surgery

Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study

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