112- What Your Spine Surgeon Hasn't Told You

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Hello and welcome to the Evidence Based Chiropractor. I AM your host Dr. Jeff Langme. Today we are going to answer the question what your surgeon hasn't told you. And if you've been following the Evidence Based Chiropractor on Facebook then you saw this topic getting a ton of activity this week. It ties back to a research study that you are definitely going to going to want to know about and we are going to talk all about it on this week's episode. Before we get started, I will say a few words as I do each and every week about Rock Tape Roc Tape is revolutionizing the soft tissue world again with new Rock Blades Mohawk. Featuring three tools in one a surgical stainless steel hand polished tool and two attachments silicon sleeve and an ABS comb. Rock Blades Mohawk unlock never before seen treatment protocols to reduce pain, improve mobility and address issues like nerve glide and neuropathy. You can get them for 175 bucks and check out educational courses@rocktape.com Mohawk Additionally on the evidence based chiropractor YouTube channel and on Facebook I just posted a recap video of rock stock 2017 so definitely check that out when you get a chance. But as I said at the top today is about the research. What what your spine surgeon maybe has not told you. That was a weird way to put it, but here is the answer to that question is that there is a research study produced in 2010 that showcased a majority of individuals who received chiropractic care or spinal manipulation succeeded to the same degree as those in the other group that that underwent surgical intervention. And that is very very important and something that all of us need to understand because to me the implication there is that very clearly the research showcases before anybody undergoes any sort of spinal surgery, unless there are extenuating circumstances or red flags, it is absolutely imperative that they go through chiropractic care be before that potential surgical intervention. Now the title of the study we're talking about is titled Manipulation or Microdissectomy for Sciatica A Prospective Randomized Clinical Study. It was released by jmpt in October 2010. Again, manipulation or Microdiscectomy for Sciatica A Prospective Randomized Clinical Study. So we all know that millions of people each and every year suffer from bulged and herniated discs that ultimately press upon the nerve root and causes tremendous pain and disability for those individuals. We also see them get well in our practice. By and large, chiropractic care is number one in terms of a conservative care option for these patients. But to me, the important part about this study is the other side of the coin. All of those individuals who are not privy to chiropractic, or maybe they are led through their PCP and through their other physicians down the road of medications, injections and surgery without the pit stop, without the intervention of chiropractic care, definitely need to be told about chiropractic before undergoing the that surgery. That is very important. Microdiscectomies, again, that type of surgery, usually it can be done inpatient or outpatient, but that is usually a single level surgery through an incision, maybe one and a half to three inches long. And that is going to be. It can be done a couple different ways. It can be done through the lamina, as in a laminotomy or laminectomy, or sometimes it's even performed percutaneously. And what we see is, is about a 10 to 20% failure rate on microdiscectomies. So it's literally the trimming back of the bulged or herniated disc off of the nerve root. Now think about that. That is very mechanical. Trimming back that disc, trimming back that nerve root off of that irritated nerve. And now think about the fact of, in this study, chiropractic care, spinal manipulation yielded just as good of a result in 60% of the patients than actually literally going in and trimming off that nerve root, or excuse me, trimming off the disc that is pressing upon that nerve root. That is very, very powerful to me. Now here's the other thing about this study that I find very interesting. Many times we hear from surgeons, from other doctors basically that, well, this patient's exhausted conservative care. They maybe have gone through, let's say, medication, let's say they've done physical therapy, perhaps they've had a little bit of best practice, tips on lifting and, you know, kind of lifestyle modification. Maybe they had acupuncture and the doc says, well, they met the threshold. They underwent NSAIDs. The NSAIDs didn't work. They did physical therapy, that didn't work. And we can clearly see the disc is pressing on the nerve. That is a go for surgical intervention. Well, here is what is really, really powerful about this study. Every single patient in this study had already undergone at least three months of non operative management, including analgesics medication, lifestyle modification, physiotherapy, massage therapy and or acupuncture. So all of these individuals had already failed all of that conservative care, yet they still, many of them fail, found success with chiropractic. So let's read a few quotes from this study that are extremely, extremely powerful to you and your patients. The researchers found unilateral lumbar radiculopathy secondary to lumbar disc herniation at 3L3, L4, L4, L5 or L5S1. That was the patient population that they looked at secondarily. As we just touched upon, the researchers found these patients must have also failed at least three months of non operative management, including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy and or acupuncture. And finally, the researchers found most of the patients who are considered surgical candidates for the treatment of radiculopathy from lumbar disc herniation improved with standardized spinal manipulative care to the same degree as those who had undergone surgery. Of those who failed spinal manipulation treatment, subsequent surgical intervention provided excellent outcome. So let's pick that last bit apart because that is a very, very important part of this study. So all of these patients were sourced from a surgeon's office, essentially. And basically what they found is many of these patients were considered surgical candidates. And again, they were put in kind of two groups, if you want to think of it this way. Some of the patients received spinal manipulation or adjustment, some of the patients received surgical intervention, and the people that received spinal manipulative care had the same degree of improvement as those who underwent surgery. So that's powerful. Now let's look at the second part of that statement. Those who failed spinal manipulation subsequently had excellent results with surgical intervention. Now, here's what we know, right? And maybe the public, our patients, our community may not be in tune with right off the bat unless we make sure that they know about it, is that once the spine is touched surgically, that's a burned bridge to a certain extent. The anatomy has physically been changed. There is scar tissue, regardless of whether it's outpatient and minimally invasive or impatient and maximally invasive. A surgical intervention is the extreme. There is a time and a place for it, don't get me wrong, but quite often it can be avoided with the proper conservative care. Now, again, the interesting part about this statement was that if those patients received chiropractic care, received spinal manipulation, and failed those individuals in the study, where that occurred and then they had surgery, it provided an excellent outcome. So for me, all signs in this study point to the fact that every single individual who undergoes a surgical intervention should be exhausting clinical chiropractic care, in addition to the other conservative measures, before even entertaining the idea of going under the knife. There are a couple exceptions to that. Again, absolute red flags, extenuating circumstances. There are a time and a place where that needs to be expedited. But in a far majority of patients that we are seeing in our practices, and let's be real about this, a far majority of the patients that are being seen in surgical practices each and every day need to get that exposure to chiropractic care before they undergo the most extreme intervention out there. Ultimately cutting on that disc, creating scar tissue, having an elongated rehabilitation process, et cetera, et cetera, et cetera. So as you can tell, this is something that I am super passionate about. Being a chiropractor who has also worked in surgical facilities, I believe it's exceptionally important that the communication between chiropractors and your local surgeon surgeons, your local medical professionals is the best that it can be. Because in my opinion, if just one person is saved from an unnecessary surgery, then all of the outreach in the world is worth it, the effort is worth it. So I would encourage everybody make sure that you are taking this sort of information, educating your patients regarding what is out there in the literature, and certainly properly and tactfully utilizing research just like this to reach out to other healthcare providers in your community. We released this for all members of the evidence based chiropractor a couple years back and it is one of our most popular past research briefs as well. Also, I put this up on my Instagram page, but we have stepped it up in 2018. The template that we utilize for the research that every single member of the evidence based chiropractor gets every single month to bridge that gap and build that relationship. We have updated it and it looks killer. If you want to check that out, go over to my Instagram page, Evidence basedchiropractor and check out a picture of what we have going on or I'm sure you'll see it around the bend shortly. So I hope you have a fantastic week in practice. Additionally, if you have been listening, thank you, thank you, thank you for listening on your way into the office each and every week. I would love it if you would give rating or feedback in itunes. It helps us reach more and more people and I think this message is one that needs to be heard. So have a great week in practice and I will talk to you soon.

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Sam.