422- Reducing Lumbar Reoperation Rates with Spinal Adjustments

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode we have an awesome piece of brand new research all about how spinal adjustments can affect and influence lumbar spine reoperation rates after discectomies. This is an awesome study. It is going to have many clinical pearls that you can have conversations with on social media with your current patients. I Love it. We're kickstarting 2024. Absolutely at the highest level possible. With research like this coming out, we're going to get into it and much more on today's episode. Before we get started, I'll say a few words about patient pilot. If you want to have free advertising, head over to the smart chiropractor.com because that's how we view email marketing. When you send email newsletters that reach opened and are read by hundreds, if not thousands of your people, your patients, each and every week, that is free advertising. Yes, some of them will click buttons that say call to schedule, click to schedule, reactivate into your practice. Many will refer friends, leave testimonials. The value is there. We are looking for docs that understand the real way of how to build a chiropractic business and serve their communities at the highest level. If you think you're one of those docs, head over to the smart chiropractor.com get started or schedule a demo. If you have any questions, we're happy to answer them. Again, that is the smart chiropractor.com but as I said at the top, we're talking research. This one just came out. I'm going to drop a link down in the show notes so you have easy access. The title is association between Spinal Manipulative Therapy and Lumbar Spine Reoperation after Disectomy. A retrospective cohort study. And this one is a banger. So we know lumbar dissect me is a surgical procedure. As you know now, they don't exactly dictate between whether it was accomplished via a laminectomy, a laminotomy, or whether it was, I'm gonna say, around the bend, so to speak. It's very difficult to do a dissectomy without affecting the lamina, but it is possible, especially in some of the more outpatient settings. But this is A surgical procedure, the design is to chop away or eat away at the disc when the disc is causing compressive pathology. So disc herniation, disc protrusion, disc fragment, disc extrusion, you name it. Discs can cause issues. They're one of the three primary items that can cause compression on a nerve root or in the lateral recess or on the spinal cord. Those three things are disc, bone and ligament. And disc is one of those and they often come together. Now, when there is compressive pathology in the lumbar spine, of course, if it's at L5S1, many will call that sciatica. And if it is higher up in the lumbar spine, then it is nerve root compression. And that can or lateral recess stenosis or central stenosis. But in the case of a nerve root, and I'm going to say the space that goes out, we're talking more lateral recess and nerve root rather than spinal cord itself, of course. So that can result in compression that has the symptomatology of, as we all know, pain, numbness, weakness, some combination, all of, of all of those items. Now, if we want to hit some stats here real quick that are really startling. Reoperation rates after lumbar disectomies 6 to 12%. 6 to 12% reoperation rate after a lumbar dissectomy. So for those patients who believe the surgery is quite quote unquote, I need to fix my problem, eh, well, there's about a 10% chance that that's not exactly gonna be the case. And then you stack onto that roughly a 20% complication rate. And I'm not sure that the marketing I'm going to say that the medical providers have done is really accurate to the truth. Because the truth is unfortunately many people in your community actually believe that having the surgical intervention, and yes, there are red flag situations. I'm taking those out of this because that happens less than 5% of the time. But for overwhelming majority, almost everybody, excluding red flags, almost everybody, they actually believe that having the surgery is going to permanently fix their problem. And anything but that is a temporary fix. The irony here is these things might be flip flopped. The actual fix is with time, is with movement based care and letting the body heal in the most applicable and appropriate manner possible by having great biomechanics, by being positive, all of the things that we know. What doesn't normally fix the problem, especially when you add to it the complication rate or doesn't resoundingly fix the problem, is the surgery itself. So reoperation within the first three months is usually because of complications, hematomas, infections, they can cause, I'm going to say early reoperations. But a majority of the reoperations don't happen in those first three months. They're actually done after the first three months because the same exact problem comes back and it's a recurrent same level disc herniation. That's the truth of the matter. And here's the other compounding component of this, which is you get two bites at the apple before a fusion is absolutely necessary, and that's maximum depending upon how well the discectomy is performed. There's only so much stuff you can take out of the spine before it falls apart is the easiest way to say it. There's only so much lamina you can take before it becomes an unstable segment. There's only so much disc you can take before it becomes an unstable segment, ligament, et cetera. So depending upon how the discectomy was performed, and I'm gonna say in some cases how well it was performed in other cases, there's just a lot that needs to be taken out and it's performed well. But sometimes, often you only get one opportunity. So the second reoperation can be a fusion. Sometimes after two operations at the same level, it's a foregone conclusion. It is exceptionally rare that anybody is able to have three bites at the apple. Three microdiscectomies, three laminotomies, three laminectomies. It practically never happens, but I'm sure it's happened once or twice in the history. And I'm guaranteeing a majority of those, that very few have been done, resulted in effusion because it didn't work. So this is a really, really, really, really big deal. Now, we also know that 20% of patients undergoing a lumbar discectomy have continued or recurrent pain or radiculopathy one year after surgery. So one in five people, one in ten are gonna have it reoperated on one in five is gonna have a complication. Another one in five is going to have the same pain happen within one year of surgery. That does not sound like a permanent fix to me. So this is a really, really, really big deal. What's also a big deal is that statistically, 11% of patients in a chiropractic practice have had spine surgery. So, you know, yours might vary a little bit, but generally speaking, 1 in 10 patients that you see is going to have a history of spine surgery. So this is something that's not an Anomaly, obviously, as we know. So this is happening all day, every day, and it's especially happening with people that haven't seen you yet, which is a whole nother soapbox. We can go on, but I'll pause on that for a moment. So this study looked at adults at least 18 years old with radiculopathy that was occurring at least one year following disectomy. So they were looking at this and saying, okay, for those people, where does spinal adjustments fit in? Like, does this make an impact? Does it not make an impact? Does it make it more likely that they'll have surgery in the future? Does it make it less likely? And that's what this study was really trying to look at. So what they found was the incidence of reoperation over a two year period following the initial surgical intervention was lower for people who received spinal adjustments than those who didn't. Now, after they went through their research based propensity matching, 7% of the individuals who had spinal adjustments had undergone a reoperation compared to 13% who hadn't. So it nearly cuts it in half. Think about how powerful that is. So, and again, this might not be the best statistics from a research perspective, but I'll piece together a few things kind of based on common sense. The likelihood that you're going to have a second surgery if you've had surgery initially, gets cut by about half if you, if you receive adjustments afterward. And this is specifically with people that were having pain. Second component is we know basically one in ten people who have surgery are gonna have a surgery again in the Future. And about 20% of those have pain. So you could potentially be bringing that to 1 in 20 instead of roughly 1 in 20 instead of 1 in 10. That is a huge, huge deal. Especially when then we go back and we say 30% of those individuals typically in usual care end up in chronic pain. That's a whole host of issues regarding medications out there. Additionally, we look at fusions in the future for many of these people. Big, big, big, big, big deal. So they also took a look at cost. I don't particularly care about cost. I believe those who pay, pay attention. I believe we undercharge as a profession dramatically for what we do. Uh, so I don't believe that just getting stuff cheaper all the time, and that's typically the way research looks at it from an expenditure perspective, as if cheaper is always better. I don't believe that to be the case, but there's an interesting citation here that the average surgery was about 14 grand in 20, 23. I don't really know. I. I'm assuming that that is making a little bit of an assumption here, but I assume that that's collected money because. Because I think the build charges are probably a lot more than that. But. So it's about 14 grand for a microdiscectomy, and they're saying it's about 65 bucks on average for a chiropractic visit. So if somebody's gonna have a. Let's compare apples to apples. If somebody's gonna have a second surgery, that's 14 grand out the door. If they receive chiropractic care at 65 bucks a pop, that means they can literally receive 200 visits for the cost of that single reoperation surgery. So that's a lot of chiropractic care. And there's no doubt in my mind based upon those numbers, I wish we were able to be able to charge more than that, because I believe the value we deliver is commiserate with that. However, if you're at about 65 bucks, you could literally be performing 200 visits for the cost of what they will pay when they get a microdiscectomy. And I'm gonna say with a lot better outcome, meaning your care with a lot better outcome, with a lot more bedside manner, with a lot more care over a period of time. My gordidectomy is 20 minutes, 30 minutes, maybe an hour long in the procedure room. Top detail. 200 visits in your practice that could take place over the course of, obviously multiple years in many cases. So that's a lot of care that can benefit their life in many ways beyond even radiculopathy, symptom reduction alone. So this is a really, really big deal. I love this study. And they also highlight the fact that spinal adjustments are considered safe, with severe adverse event occurring anywhere from less than 1 to 7 in 100,000 treatments. That's wild. I mean, that is. When we look at 20% complication. Now they're saying serious adverse events. So I am comparing a little bit of apples to oranges here. It's not 20% of surgeries have severe adverse events, but it's 20% complication rate. With the spinal adjustment, you're looking at 1 or 7 in 100,000 treatments. That is a lot. That is extreme safety. This is why it just blows my mind. When you look at YouTube, when you look at X, when you look at wherever you're looking online and you see comments about who we are and what we do, and they're so outside the realm of Reality in many cases when people are concerned. Now should we be good clinicians and understand risk factors and mitigate those risk factors? Of course we should. But that does. But the safety of a chiropractic adjustment far exceeds the safety of medications, far exceeds the safety of surgery. These aren't even in the same ballpark. Yet many people do believe still still today, many people believe that a chiropractic adjustment is risky and can cause disc herniations and cause all of these issues. And while we're not immune, we're providing a service and there are always risks with any service. The risk factors are so incredibly low that that compared to everything else, it's almost difficult even to compare apples to oranges. So what does that mean? That means we're not doing a great job getting the word out there. So that's why I have the evidence based chiropractor for referral relationships with other healthcare providers. You can check it out at the evidence based chiropractor. That's how why we have patient pilot with the smart chiropractor which is getting information out to your patients consistently. We need to do a better job as a profession and that starts individually getting out there. And that's taking action. Whether you want to shoot videos online, whether you want to use email, which we recommend because it's automated, you can reach a ton of people each and every week. Whether you want to get out there to other healthcare providers, the answer is not this or that. The best answer for the best practices and to really raise us up is this and that. And that's why I built the product set that I love and why we use that in the practice that I own as well. But tying it back to this research, they found as a conclusion quote, this study found that adults receiving spinal manipular therapy for radiculopathy at least 1 year after lumbar dissectomy were less likely to undergo lumbar spine reoperation compared to those receiving usual care without spinal manipular therapy. A difference which persisted over two years. Follow up. So awesome study. Kudos to everybody involved with getting this out there. I know studies take a long time, they are hard and they are expensive. So well done to everybody getting this out there. It's brand new. I'll drop a link down in the show notes and before we wrap up, I want to say a few words about align of sleep. If you have a pillow at home, do you have a pillow at home? If you have a pillow at home, make it on a line of sleep pillow it's what I use. They support this podcast. You just support them. I'll take one step farther. Do you have pillows in your practice? Do you use this as a revenue opportunity because people ask you. I know people ask you about what pillow you recommend. Align of Sleep is the pillow I'm gonna recommend that you recommend. You can check it out@alignasleep.com Fantastic company, fantastic product. Additionally, Shockwave I can't go online without seeing a question about Shockwave. Does it work? Should I have it? Shockwave technology is legit. It's real deal and I use stemwave in the practice that I own. Go stemwave.com the evidence basedchiropractor if you want to learn about the technology, just have a conversation with their team. I'll drop a link down in the show notes go stemwave.com the evidencebasedchiropractor the technology is awesome. Can't recommend the company enough. They support the podcast. They support the practice that I'm in. It's the technology I literally use. Go stemwave.com the evidence basedchiropractor have a conversation with them. They'll hook you up with their best deal at knowing that you're coming over from so that is it on today's episode. If you have not left a rating or review for this show, I would love it if you would take a moment and do so. That helps us reach more and more people. Thank you for being a chiropractor. Have an awesome week in practice and I will talk to you soon.

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Sam.