Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study

Robert J. Trager; Jordan A. Gliedt; Collin M. Labak; Clinton J. Daniels; Jeffery A. Dusek

doi:10.1186/s12891-024-07166-x

Table 1

Baseline characteristics before and after propensity matching

Variable SMT Usual medical care SMD (P-value) SMT Usual medical care SMD (P-value)
N 380 1,931 378 378
Age* 60.8 (14.6) 56.5 (14.9) 0.292 (< 0.001) 60.8 (14.6) 60.9 (14.3) 0.009 (0.904)
BMI* 30.6 (6.3) 30.4 (6.5) 0.024 (0.73) 30.6 (6.3) 30.0 (6.3) 0.107 (0.226)
Female 239 (63%) 998 (52%) 0.228 (< 0.001) 237 (63%) 194 (51%) 0.231 (0.002)
Male 141 (37%) 932 (48%) 0.227 (< 0.001) 141 (37%) 183 (48%) 0.226 (0.002)
Not Hispanic or Latino 343 (90%) 1704 (88%) 0.065 (0.258) 341 (90%) 342 (90%) 0.009 (0.902)
Hispanic or Latino ≤ 10 (3%) 30 (2%) 0.075 (0.141) ≤ 10 (3%) ≤ 10 (3%) 0 (1)
American Indian or Alaska Native 0 (0%) 11 (1%) 0.107 (0.14) 0 (0%) ≤ 10 (3%) 0.233 (0.001)
Asian 0 (0%) 28 (1%) 0.172 (0.018) 0 (0%) ≤ 10 (3%) 0.233 (0.001)
Black or African American 0 (0%) 27 (1%) 0.168 (0.02) 0 (0%) ≤ 10 (3%) 0.233 (0.001)
Native Hawaiian or Other Pacific Islander 0 (0%) 13 (1%) 0.116 (0.109) 0 (0%) ≤ 10 (3%) 0.233 (0.001)
White 343 (90%) 1683 (87%) 0.098 (0.092) 341 (90%) 340 (90%) 0.009 (0.903)
Other race ≤ 10 (3%) ≤ 10 (1%) 0.170 (< 0.001) ≤ 10 (3%) ≤ 10 (3%) 0 (1)
Nicotine dependence* 33 (9%) 271 (14%) 0.169 (0.005) 33 (9%) 35 (9%) 0.018 (0.799)
Spondylolisthesis, lumbar* ≤ 10 (3%) 33 (2%) 0.063 (0.224) ≤ 10 (3%) ≤ 10 (3%) 0 (1)
Spondylolisthesis, lumbosacral* ≤ 10 (3%) ≤ 10 (1%) 0.170 (< 0.001) ≤ 10 (3%) ≤ 10 (3%) 0 (1)
Chiropractic manipulative treatment 310 (82%) 114 (6%) 2.359 (< 0.001) 309 (82%) 39 (10%) 2.054 (< 0.001)
Computed tomography, lumbar spine ≤ 10 (3%) 65 (3%) 0.043 (0.46) ≤ 10 (3%) 14 (4%) 0.060 (0.407)
Magnetic resonance imaging, lumbar 56 (15%) 251 (13%) 0.05 (0.361) 55 (15%) 57 (15%) 0.015 (0.838)
Physical therapy evaluation 23 (6%) 60 (3%) 0.141 (0.005) 21 (6%) 10 (3%) 0.147 (0.044)
Lumbar or sacral transforaminal steroid injection 19 (5%) 130 (7%) 0.074 (0.209) 18 (5%) 30 (8%) 0.130 (0.073)
Lumbar or sacral epidural steroid injection ≤ 10 (3%) 22 (1%) 0.110 (0.023) ≤ 10 (3%) ≤ 10 (3%) 0 (1)
Emergency visit 77 (20%) 400 (21%) 0.011 (0.842) 77 (20%) 71 (19%) 0.040 (0.582)
NSAIDs 193 (51%) 992 (51%) 0.012 (0.835) 192 (51%) 214 (57%) 0.117 (0.109)
Opioid analgesics 187 (49%) 1087 (56%) 0.142 (0.011) 187 (49%) 225 (60%) 0.203 (0.006)
Skeletal muscle relaxants 84 (22%) 553 (29%) 0.151 (0.009) 84 (22%) 108 (29%) 0.146 (0.045)
Gabapentinoids 65 (17%) 406 (21%) 0.100 (0.083) 65 (17%) 93 (25%) 0.183 (0.012)
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Abbreviations: Body mass index (BMI); nonsteroidal anti-inflammatory drugs (NSAIDs); standardized mean deviation (SMD); spinal manipulative therapy (SMT). Chiropractic manipulative therapy includes chiropractic SMT as well as extraspinal manipulation provided by a chiropractor
* Propensity-matched variables (other variables reported for descriptive purposes)

Variable	SMT	Usual medical care	SMD (P-value)	SMT	Usual medical care	SMD (P-value)
N	380	1,931		378	378
Age*	60.8 (14.6)	56.5 (14.9)	0.292 (< 0.001)	60.8 (14.6)	60.9 (14.3)	0.009 (0.904)
BMI*	30.6 (6.3)	30.4 (6.5)	0.024 (0.73)	30.6 (6.3)	30.0 (6.3)	0.107 (0.226)
Female	239 (63%)	998 (52%)	0.228 (< 0.001)	237 (63%)	194 (51%)	0.231 (0.002)
Male	141 (37%)	932 (48%)	0.227 (< 0.001)	141 (37%)	183 (48%)	0.226 (0.002)
Not Hispanic or Latino	343 (90%)	1704 (88%)	0.065 (0.258)	341 (90%)	342 (90%)	0.009 (0.902)
Hispanic or Latino	≤ 10 (3%)	30 (2%)	0.075 (0.141)	≤ 10 (3%)	≤ 10 (3%)	0 (1)
American Indian or Alaska Native	0 (0%)	11 (1%)	0.107 (0.14)	0 (0%)	≤ 10 (3%)	0.233 (0.001)
Asian	0 (0%)	28 (1%)	0.172 (0.018)	0 (0%)	≤ 10 (3%)	0.233 (0.001)
Black or African American	0 (0%)	27 (1%)	0.168 (0.02)	0 (0%)	≤ 10 (3%)	0.233 (0.001)
Native Hawaiian or Other Pacific Islander	0 (0%)	13 (1%)	0.116 (0.109)	0 (0%)	≤ 10 (3%)	0.233 (0.001)
White	343 (90%)	1683 (87%)	0.098 (0.092)	341 (90%)	340 (90%)	0.009 (0.903)
Other race	≤ 10 (3%)	≤ 10 (1%)	0.170 (< 0.001)	≤ 10 (3%)	≤ 10 (3%)	0 (1)
Nicotine dependence*	33 (9%)	271 (14%)	0.169 (0.005)	33 (9%)	35 (9%)	0.018 (0.799)
Spondylolisthesis, lumbar*	≤ 10 (3%)	33 (2%)	0.063 (0.224)	≤ 10 (3%)	≤ 10 (3%)	0 (1)
Spondylolisthesis, lumbosacral*	≤ 10 (3%)	≤ 10 (1%)	0.170 (< 0.001)	≤ 10 (3%)	≤ 10 (3%)	0 (1)
Chiropractic manipulative treatment	310 (82%)	114 (6%)	2.359 (< 0.001)	309 (82%)	39 (10%)	2.054 (< 0.001)
Computed tomography, lumbar spine	≤ 10 (3%)	65 (3%)	0.043 (0.46)	≤ 10 (3%)	14 (4%)	0.060 (0.407)
Magnetic resonance imaging, lumbar	56 (15%)	251 (13%)	0.05 (0.361)	55 (15%)	57 (15%)	0.015 (0.838)
Physical therapy evaluation	23 (6%)	60 (3%)	0.141 (0.005)	21 (6%)	10 (3%)	0.147 (0.044)
Lumbar or sacral transforaminal steroid injection	19 (5%)	130 (7%)	0.074 (0.209)	18 (5%)	30 (8%)	0.130 (0.073)
Lumbar or sacral epidural steroid injection	≤ 10 (3%)	22 (1%)	0.110 (0.023)	≤ 10 (3%)	≤ 10 (3%)	0 (1)
Emergency visit	77 (20%)	400 (21%)	0.011 (0.842)	77 (20%)	71 (19%)	0.040 (0.582)
NSAIDs	193 (51%)	992 (51%)	0.012 (0.835)	192 (51%)	214 (57%)	0.117 (0.109)
Opioid analgesics	187 (49%)	1087 (56%)	0.142 (0.011)	187 (49%)	225 (60%)	0.203 (0.006)
Skeletal muscle relaxants	84 (22%)	553 (29%)	0.151 (0.009)	84 (22%)	108 (29%)	0.146 (0.045)
Gabapentinoids	65 (17%)	406 (21%)	0.100 (0.083)	65 (17%)	93 (25%)	0.183 (0.012)