Posted by: Dr. Paul Zemella - Santa Barbara Chiropractor | August 21, 2011

Chiropractic Services vs Spinal Surgery

Chiropractic services is gaining popularity as a treatment for scoliotic patients since it has been proven to be just as effective, if not more, than the existing treatment options for scoliosis. Chiropractic does not only treat any existing problems but also prevents further progression of the curves that is causing the problem. Those patients who’ve undergone chiropractic care for scoliosis have shown momentous improvement in size of the curves and this include [sic] 70 percent of them. This is important since any relief from scoliosis means that a patient won’t have to undergo surgery, take medications, and suffer from the effects of scoliosis.

That is not to say, however, that conventional treatment is beyond criticism.  Negrini (2008) argues that, in treating AIS, “[…] in clinics exercises are generally ignored; braces are used with some criticism, while fusion is generally considered the only reliable treatment.”  And this despite evidence of efficacy for exercises and bracing being, in her opinion, better than that for surgical fusion (“grade B, B and C recommendations, respectively”)  She continues, making the point that, “The interest of the AIS treatment community (composed almost exclusively by orthopedic surgeons) has shifted toward fusion […] while conservative treatment is suffering a decrease in professional interest.”

The views of this author could be coloured by a commitment to exercise as a treatment, however, it is an interesting view backed up by evidence – in contrast to the propaganda offered by this pro-chiropractic services.  “No controlled study, neither short, mid nor long-term, was found to reveal any substantial evidence to support surgery as a treatment for this condition. There is some evidence supporting the conservative treatment for AIS. No substantial evidence has been found in terms of prospective controlled studies to support surgical intervention. In light of the unknown long-term effects of surgery, a randomised controlled trial (RCT) seems necessary. Due to the presence of evidence to support conservative treatments, a plan to compose a RCT for conservative treatment options seems unethical. But it is also important to conclude that the evidence for conservative treatments is weak in number and length.”

Given this, it is odd that UK’s Scoliosis Association are very positive about appropriate surgery; as are the UK’s NHS and support4scoliosis.  This apparent dichotomy may indicate that the evidence base for conventional treatments could do with improving.  However, it does not provide a justification for the use of chiropractic services.  Having looked at what evidence I can find, it’s clear that it isn’t decisive for any conservative intervention.  However, it seems to be pretty reasonable to think that bracing (Rowe, et al, 1997) and exercise have merit. It’s also clear that surgery is widely recommended by credible authorities, although the evidence base would seem to be sparse.  This makes me wonder: is this because it’s not as effective as people think, or is it because RCTs are hard to justify ethically and conduct for surgical interventions?  I don’t know and would be interested to hear from people who do.

So, what of the ‘package’ of potential treatments listed in this article?  One thing is very clear: there is absolutely no good reason to suppose that chiropractic services spinal manipulation offers anything beyond making some people feel better if they are in pain. Shoe lifts might have some merit, but they have been insufficiently researched for anyone to say. Electrical stimulation is a treatment whose time has passed.  For a while it looked like it might be effective, now the best available evidence says otherwise.

The most truthful claim in the article is the implication that, “isotonic or active exercise methods” might be useful.  I am not sure that these specific exercises have much merit, but there are examples of exercise regimes in the literature that look like they do.  At the end of the day, AIS is a condition that mostly resolves itself over time.  For the 10% of children who need treatment, braces and exercise look like the only conservative options.  For those whose condition is the most severe, the decision to try the surgical option must be a difficult one.

The combination of a large number of cases that will get better anyway and limited –as well as intimidating – conventional options provides the classic environment for marketing CAM ‘treatments’.  The kind of opportunistic plugging of un-evidenced and disproven therapies seen in this article can only serve the financial interests of those who make a living from selling these treatments: it cannot serve the interests of patients and their families.  Neither does it help the broader challenge of bringing cost-effective medical care to communities as a whole.

Unless and until advocates for alternative therapies can provide decent evidence for the interventions they espouse, or at least discuss the evidence in a truthful and balanced way, I would really like to see them showing some modesty and limiting their claims to helping people to feel better; as opposed to actually making people better.

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Responses

  1. Many people have the fear of starting chiropractic care because they’ve heard that they’ll have to keep going for the rest of their lives. That’s true or false, depending on how you look at it. In the beginning of care, a chiropractor has to help you work through many years of abuse and subluxations


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