SMT And Cauda Equina & SMT And Discectomy

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 326: SMT And Cauda Equina & SMT And Discectomy Today we’re going to talk about SMT And Cauda Equina & SMT And Discectomy But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [e-mail] If you haven’t yet I have a few things you should do.

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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You have found yourself smack dab in the middle of Episode #326 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11) . Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

By the time this one goes live, I’ll be on my way to the Modern Chiropractic Mastermind meeting and this time, it’s not in Florida. Dangit. But, it’s in Nashville so that’s not so bad. No beaches in Nashville but we can handle it. I’m a musician and all and I have some musician friends in Nashville so it should be a lot of fun and a good opportunity to learn a ton. I have a thought and I’m trying it out. What about giving instead of just traditional marketing?/ Here’s what I mean; my wife and I went to a greenhouse here close to our office the other day.

It’s been there for years but we’ve never gone and, for some reason, we just wondered in there because we’re replacing the front yard at our local airbnb. Turns out that while it’s been there for years, there are new owners. A young couple. They look like they’re 30 years old. All bright eyed and bushy tailed. They talked to everyone that came in. They helped my wife design the new yard down to the little details for nothing. You can tell they genuinely love owning this new business and their new journey. Made me want to help them. It made me want them to be successful and to root for them. I know what it feels like to feel like to feel alone. Like it’s just you and nobody else cares. Nobody else has your back. No matter what you do for the community.

No matter what you do for you patients. I know that frustration and stress and anxiety and worry when you feel like the cards are stacked against you and you have nobody in your corner that gives a squirt about helping you. I get it. So I took pictures, I asked questions, and I decided to highlight this young couple and this new business venture of theirs and put it on my company social media. No trade outs. I didn’t ask them to highlight us in return. I didn’t ask them to send me any patients. Nothing. I just wanted to give. I just did it this afternoon.

But lets see what happens. I’m curious. I genuinely want them to succeed but what if giving means you receive as well. I’ll let you know. I always thought a good guerrilla marketing technique would be to pick a business in the community and basically ‘affiliate’ with them for one month. Share their social media posts. Talk ‘em up. Visit their building and take and post pics on your business socials. They do the same in return. Then the next month, you do the same thing.

Or…..what if I just pick out good businesses with owners that I really like and just highlight them like this with no expectations of anything in return. I’m curious. I’ll let you know. Seems like it’s all be really good in lots of ways.

Item #1

First one today is called, “Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data” by Trager et. Al and published in BMJ Open on December 16, 2022.

Remember, the citations can be found at chiropracticforward.com under this episode.

Trager RJ, Daniels CJ, Perez JA, Casselberry RM, Dusek JA. Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data. BMJ Open. 2022 Dec 16;12(12):e068262. doi: 10.1136/bmjopen-2022-068262. PMID: 36526306; PMCID: PMC9764600.

Why They Did It Chiropractic spinal manipulative therapy (CSMT) and lumbar discectomy are both used for lumbar disc herniation (LDH) and lumbosacral radiculopathy (LSR); however, limited research has examined the relationship between these therapies. We hypothesised that adults receiving CSMT for newly diagnosed LDH or LSR would have reduced odds of lumbar discectomy over 1-year and 2-year follow-up compared with those receiving other care.

How They Did It Design: Retrospective cohort study.

Setting: 101 million patient US health records network (TriNetX), queried P

articipants were Adults age 18-49 with newly diagnosed lumbar disc herniation/lumbosacral radiculopathy (first date of diagnosis) were included. Exclusions were prior lumbar surgery, absolute indications for surgery, trauma, spondylolisthesis and scoliosis.

Interventions: Patients were divided into cohorts according to receipt of SMT.

What They Found

• 5785 patients per cohort.
• The ORs for discectomy were significantly reduced in the CSMT cohort compared with the cohort receiving other care over 1-year, and 2-year follow-up.

Wrap It Up

• Our findings suggest receiving CSMT compared with other care for newly diagnosed lumbar disc herniation/lumbosacral radiculopathy is associated with significantly reduced odds of discectomy over 2-year follow-up.
• Given socioeconomic variables were unavailable and an observational design precludes inferring causality, the efficacy of CSMT for lumbar disc herniation/lumbosacral radiculopathy should be examined via randomised controlled trial to eliminate residual confounding.

Item #2

Our second one today is called, “Association between chiropractic spinal manipulation and cauda equina syndrome in adults with low back pain: Retrospective cohort study of US academic health centers” by Trager et al and published in Plos One on March 11, 2024

…..what what, it’s getting hot in here….So read up all the research…

Trager, R. J., Baumann, A. N., Perez, J. A., Dusek, J. A., Perfecto, P. T., & Goertz, C. M. (2024). Association between chiropractic spinal manipulation and cauda equina syndrome in adults with low back pain: Retrospective cohort study of US academic health centers. PLOS ONE, 19(3), e0299159. https://doi.org/10.1371/journal.pone.0299159

Why They Did It

Cauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). The study hypothesis was that there would be no increase in the risk of caudal equina in adults with LBP following smt compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period.

How They Did It A query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing Cauda equina, incontinence, or serious pathology that may cause Cauda equina. Patients were divided into two cohorts: (1) LBP patients receiving smt or (2) LBP patients receiving PT evaluation without spinal manipulation.

What They Found 67,220 patients per cohort (mean age 51 years) remained after propensity matching. Cauda equina incidence was 0.07% in the CSM cohort compared to 0.11% in the PT evaluation cohort Both cohorts showed a higher rate of Cauda equina during the first two weeks of follow-up.

Wrap It Up These findings suggest that CSM is not a risk factor for Cauda equina. Considering prior epidemiologic evidence, patients with LBP may have an elevated risk of v independent of treatment. Bam, snap, pow!, crash, kadonk!

Oh how I love research. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

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