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

Abstract

IntroductionThere are limited available research and guidance regarding the use of spinal manipulative therapy (SMT) in patients with low back-related symptoms following lumbar spine surgery, a condition called persistent spinal pain syndrome type 2 (PSPS-2). This publication outlines a review protocol to identify and synthesise individual participant data (IPD) to examine associations between patient, clinical and surgical variables and SMT application in adults with PSPS-2.Methods and analysisPubMed, OVID, Web of Science, Scopus, PEDro, Index to Chiropractic Literature and KoreaMed will be searched from inception to 1 January 2022 without language restrictions. Case reports, series, observational studies and cases from grey literature of adults receiving SMT for PSPS-2 will be included. Two investigators will independently screen citations, abstracts and full-text articles. A risk-of-bias assessment will be performed in duplicate to rate cases according to exposure and outcome ascertainment and data completeness. Data extraction will be performed in duplicate and missing IPD will be requested from corresponding authors. Multiple binary logistic regression will be used to identify independent predictors of the use of lumbar–SMT, lumbar–manual-thrust SMT and SMT within 1-year postsurgery. Patient, clinical and surgical variables will be summarised using descriptive statistics, while SMT-related outcomes (lumbar–SMT, lumbar–manual-thrust SMT and 1-year surgery-to-SMT interval) will be described using adjusted ORs with 95% CIs.Ethics and disseminationThis study was deemed not human subjects research by the University Hospitals’ institutional review board. The results of this review will be disseminated at conferences and/or published in a peer-reviewed journal.PROSPERO registration numberCRD42021250039.

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

“…In designing the regression model, a select number of key covariates were chosen from the available dataset. This process was guided by previous research on this topic [ 7 ]. Our present study included 7 covariates in each regression model, which accordingly required at least 14 subjects for this method of analysis.…”

“…Despite the growing, aging population with PSPS-2, there is no consensus regarding the optimal treatment for this condition [ 4 ]. While conservative therapies such as physical therapy, medication, and injections are often recommended instead of revision surgery [ 4 , 5 ], little research has examined the utility of chiropractic spinal manipulative therapy (CSMT) for PSPS-2 [ 6 , 7 ].…”

“…Spinal manipulation is an evidence-based therapy and is recommended by several practice guidelines for LBP [ 10 – 12 ]. However, few large-scale studies have explored the effectiveness of CSMT for PSPS-2, with the majority of evidence derived from case reports and series [ 6 , 7 , 13 ].…”

“…CSMT has several contraindications, including manipulation of the spine in the presence of spinal infection or malignancy [ 18 , 19 ]. Currently, less is known about precautions to CSMT in patients with previous spinal surgery [ 7 ]. However, limited evidence suggests that CSMT can be safely administered in this patient population [ 6 ].…”

“…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 ].…”