Chiropractic care is a great conservative treatment option for the low back pain patient. While many patients visit a chiropractor to avoid progressing to surgery, there are individuals with a history of back pain who did opt for surgery but continue to experience pain and disability. Can a doctor of chiropractic help the post-surgery low back pain patient?
The current term to describe the post-surgical patient who continues to report pain is persistent spinal pain syndrome-2 (PSPS-2). Older terms the reader may have previously seen or heard include failed back surgery syndrome (FBSS), postlaminectomy syndrome, adjacent-segment degeneration, chronic spinal pain after surgery, and postsurgical spine syndrome. A 2017 systemic review estimated that—depending on the criteria used—PSPS-2 may occur in between 4%-50% of patients following low back surgery.
The average person’s lumbar spine contains five motion segments (L1-L5), but a small percentage may have an additional vertebra that can increase the movement of the spine and reduce its stability. Individuals with this spinal variation may undergo a fusion procedure to reduce spinal movement and increase stability. When such a patient seeks chiropractic care, their doctor of chiropractic will have to consider not only the effect that fusion poses on the adjacent levels above and below the fused region, but also the type of biomaterials used in the fusion process. For example, plates and rods are often anchored to the vertebra using screws, which can loosen or break. In these cases, a non-thrust treatment method, such as spinal mobilization or myofascial release, may be the appropriate choice.
Doctors of chiropractic also have the option to utilize spinal manipulation, which is a single high-velocity, low amplitude (HVLA) impulse that’s delivered to a spinal region to improve movement where it is lacking. In the end, the choice of treatment can depend on several factors, such as patient and provider preference, the presence of osteoporosis or hypermobility, safety concerns such as near or in the region of hardware, and patient comfort during the pre-manipulative set-up.
A systematic review published in 2020 that looked at data from 51 studies found moderate evidence for recommending non-thrust therapies such as neuromobilization and myofascial release versus other manual therapies for the post-lumbar fusion PSPS-2 patient. The review did not determine that either thrust or non-thrust therapies are more effective for other surgical interventions and recommended more research on the topic. Until then, the most appropriate approach used will depend on the patient’s unique case, their treatment preferences, and their chiropractor’s training and clinical experience.