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Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study
BackgroundPatients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years' follow-up.MethodsWe searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits.ResultsFollowing propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35-0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6).ConclusionsThis study found that adults experiencing LSR at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT. While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance. We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture.RegistrationOpen Science Framework ( https://osf.io/vgrwz )
Additional file 1 of Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study
Supplementary Material
The SHARE European Earthquake Catalogue (SHEEC) 1000–1899
In the frame of the European Commission
project “Seismic Hazard Harmonization in Europe”
(SHARE), aiming at harmonizing seismic hazard at a
European scale, the compilation of a homogeneous,
European parametric earthquake catalogue was planned.
The goal was to be achieved by considering the most
updated historical dataset and assessing homogenous
magnitudes, with support from several institutions. This
paper describes the SHARE European Earthquake
Catalogue (SHEEC), which covers the time window
1000–1899. It strongly relies on the experience of the
European Commission project “Network of Research
Infrastructures for European Seismology” (NERIES), a
module of which was dedicated to create the European
“Archive of Historical Earthquake Data” (AHEAD) and
to establish methodologies to homogenously derive earthquake
parameters from macroseismic data. AHEAD has
supplied the final earthquake list, obtained after sorting duplications out and eliminating many fake events; in
addition, it supplied the most updated historical dataset.
Macroseismic data points (MDPs) provided by AHEAD
have been processed with updated, repeatable procedures,
regionally calibrated against a set of recent, instrumental
earthquakes, to obtain earthquake parameters. From the
same data, a set of epicentral intensity-to-magnitude relations
has been derived,with the aimof providing another set
of homogeneous Mw estimates. Then, a strategy focussed
on maximizing the homogeneity of the final epicentral
location and Mw, has been adopted. Special care has been
devoted also to supply location and Mw uncertainty. The
paper focuses on the procedure adopted for the compilation
of SHEEC and briefly comments on the achieved results