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Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence

BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1511 (Published 08 July 2021) Cite this as: BMJ 2021;374:n1511

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Re: Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence

Dear Editor

The comparative studies on Lumbar Disc Degeneration did not include three of the most important conservative care treatments--classic chiropractic spinal adjustments, flexion-distraction therapy, and nonsurgical spinal decompression.

2010: the North American Spine Society journal published an article, “NASS Contemporary Concepts in Spine Care: Spinal Manipulation Therapy For Acute Low Back Pain,” admitting spine fusion should be a last resort and recommended spinal manipulation—5 to 10 sessions over 2 to 4 weeks—should be considered before surgery.

2016: Chiropractic Distraction Spinal Manipulation on Post-surgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series, James Cox et al. examined 69 post-surgical continued pain (FBSS) patients who afterwards received Cox Technic Flexion Distraction (CTFD). Results showed greater than 50% pain relief following CTFD chiropractic distraction spinal manipulation was seen in 81% of post-surgical patients receiving a mean of 11 visits over a 49-day period of active care. At 24-month follow-up, of 56 patients available, 44 (78.6%) had continued pain relief of greater than 50% and 10 (18%) reported 50% or less relief.

2021: DRX9000: True Spinal Decompression: Summary of the Literature:
Research article Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study
Christian C Apfel*1,5, Ozlem S Cakmakkaya1,5, William Martin2,5, Charlotte Richmond3,5, Alex Macario4,5, Elizabeth George1,5, Maximilian Schaefer1,5 and Joseph V Pergolizzi4,5

These three treatments used alone or together would avoid lumbar fusion surgery and lower costs.

Competing interests: No competing interests

13 September 2021
JAMES C. SMITH
Chiropractor
Chiropractors for Fair Journalism.
Warner Robins, Georgia 31088