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

Daniels, Clinton J.; Cupler, Zachary A.; Gliedt, Jordan A.; Walters, Sheryl; Schielke, Alec L; Hinkeldey, Nathan; Golley, Derek J.

doi:10.1016/j.ctcp.2020.101261

Cited by 8 publications

(17 citation statements)

References 110 publications

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“…This sample appeared feasible based on a prior review including patients receiving SMT following lumbar surgery. 22 …”

Section: Methodsmentioning

confidence: 99%

“…A list of terms ( table 1 ) was adapted from a previous systematic review on the topic of manual therapies for patients with prior lumbar surgery. 22 Changes included removal of terms related to soft-tissue therapies and stretching, and addition of terms relating to traditional East Asian SMT (eg, chuna and tuina). The search was broadened by combining terms for low back conditions and prior procedures with a Boolean ‘OR’ as opposed to searching for these separately.…”

Section: Methodsmentioning

confidence: 99%

“…This sample appeared feasible based on a prior review including patients receiving SMT following lumbar surgery. 22 Eligibility criteria Population Included articles must describe patient(s) aged 18-89 with PSPS-2, with persistent spinal pain in the context of previous spinal surgery. 1 An age cut-off of 89 was used as an individual's age 90 and above is considered a patient identifier by the Health Insurance Portability and Accountability Act, 41 and external individual participant data (IPD) requests are planned.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…20 Research is limited regarding the application of SMT in PSPS-2. [21][22][23] One recent systematic review identified multiple patients who benefited from SMT following discectomy, laminectomy, fusion, disc replacement and/ or spinal cord stimulator placement, but found inconclusive evidence to recommend for or against SMT in these patients. 22 Another review found insufficient evidence supporting the use of joint mobilisation postlumbar fusion.…”

Section: Introduction Rationalementioning

confidence: 99%

“…[21][22][23] One recent systematic review identified multiple patients who benefited from SMT following discectomy, laminectomy, fusion, disc replacement and/ or spinal cord stimulator placement, but found inconclusive evidence to recommend for or against SMT in these patients. 22 Another review found insufficient evidence supporting the use of joint mobilisation postlumbar fusion. 21 Educational materials provide differing recommendations of SMT technique for patients postlumbar surgery, such as advising mobilisation away from the surgical site, 24 treatment modification, 25 avoidance of lower lumbar rotation 26 or no passive range of motion for 3 months at levels affected by surgery.…”

Section: Introduction Rationalementioning

confidence: 99%

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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

et al. 2021

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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.

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“…This sample appeared feasible based on a prior review including patients receiving SMT following lumbar surgery. 22 …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Sample Size Calculationmentioning

confidence: 99%

Section: Introduction Rationalementioning

confidence: 99%

Section: Introduction Rationalementioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2021

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Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study

Trager,

Gliedt,

Labak

et al. 2024

BMC Musculoskelet Disord

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Background Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years’ follow-up. Methods We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits. Results Following propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35–0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6). Conclusions This study found that adults experiencing LSR at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT. While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance. We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture. Registration Open Science Framework (https://osf.io/vgrwz).

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Clinician approaches to spinal manipulation for persistent spinal pain after lumbar surgery: systematic review and meta-analysis of individual patient data

et al. 2023

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Background This review aimed to identify variables influencing clinicians’ application of spinal manipulative therapy (SMT) for persistent spine pain after lumbar surgery (PSPS-2). We hypothesized markers of reduced clinical/surgical complexity would be associated with greater odds of applying SMT to the lumbar region, use of manual-thrust lumbar SMT, and SMT within 1-year post-surgery as primary outcomes; and chiropractors would have increased odds of using lumbar manual-thrust-SMT compared to other practitioners. Methods Per our published protocol, observational studies describing adults receiving SMT for PSPS-2 were included. PubMed, Web of Science, Scopus, OVID, PEDro, and Index to Chiropractic Literature were searched from inception to January 6, 2022. Individual patient data (IPD) were requested from contact authors when needed for selection criteria. Data extraction and a customized risk-of-bias rubric were completed in duplicate. Odds ratios (ORs) for primary outcomes were calculated using binary logistic regressions, with covariates including age, sex, symptom distribution, provider, motion segments, spinal implant, and surgery-to-SMT interval. Results 71 articles were included describing 103 patients (mean age 52 ± 15, 55% male). The most common surgeries were laminectomy (40%), fusion (34%), and discectomy (29%). Lumbar SMT was used in 85% of patients; and of these patients was non-manual-thrust in 59%, manual-thrust in 33%, and unclear in 8%. Clinicians were most often chiropractors (68%). SMT was used > 1-year post-surgery in 66% of cases. While no primary outcomes reached significance, non-reduced motion segments approached significance for predicting use of lumbar-manual-thrust SMT (OR 9.07 [0.97–84.64], P = 0.053). Chiropractors were significantly more likely to use lumbar-manual-thrust SMT (OR 32.26 [3.17–327.98], P = 0.003). A sensitivity analysis omitting high risk-of-bias cases (missing ≥ 25% IPD) revealed similar results. Conclusions Clinicians using SMT for PSPS-2 most often apply non-manual-thrust SMT to the lumbar spine, while chiropractors are more likely to use lumbar-manual-thrust SMT relative to other providers. As non-manual-thrust SMT may be gentler, the proclivity towards this technique suggests providers are cautious when applying SMT after lumbar surgery. Unmeasured variables such as patient or clinician preferences, or limited sample size may have influenced our findings. Large observational studies and/or international surveys are needed for an improved understanding of SMT use for PSPS-2. Systematic review registration PROSPERO (CRD42021250039).

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

Cited by 8 publications

References 110 publications

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

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

Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study

Clinician approaches to spinal manipulation for persistent spinal pain after lumbar surgery: systematic review and meta-analysis of individual patient data

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