Chiropractic spinalmanipulation associated with reduction in low back surgery UHhospitals BMJ_Open
which could affect propensity matching or impact a patient’s eligibility for the current study. We were also unable to examine data completeness for all variables at an individual patient level. It was not feasible to validate our query against a gold standard of chart review given data was deidentified and sourced from outside healthcare organisations.
Third, we are unable to determine the techniques of CSMT employed by chiropractors for each patient, which may have differing efficacy.Knowledge of techniques performed such as mobilisation, low-force, or high-velocity, low-amplitude CSMT could allow us to standardise the CSMT cohort to include a more uniform treatment, or enable subgroup analysis according to technique .
Fourth, we were unable to examine the likelihood of visiting a surgeon due to a lack of provider codes in the dataset. Previous research has found that patients who initiate care for low back pain with a chiropractor have significantly reduced odds of visiting a surgeon.Accordingly, it is unclear if a difference in surgical visits between cohorts mediates the association observed in our study.
Finally, as the study results derived from large, academically affiliated healthcare institutions, they may not be generalisable to patients seeking chiropractic care in private facilities.These findings suggest that patients receiving CSMT for newly diagnosed LDH and/or LSR without serious pathology, spinal deformity or absolute indications for surgery have significantly reduced odds of discectomy through 2-year follow-up after index diagnosis compared with those receiving other care.