News Release

Chiropractic spinal manipulation associated with reduction in low back surgery

New Study Published in BMJ Open

Peer-Reviewed Publication

University Hospitals Cleveland Medical Center

UH Cleveland Medical Center

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Credit: University Hospitals

CLEVELAND – A recent study from University Hospitals (UH) Connor Whole Health found that adults who initially visit a chiropractor to receive spinal manipulation for low back pain caused by disc herniation or radiculopathy (i.e., sciatica) are less likely to undergo discectomy (i.e., disc surgery) over the subsequent two years. This study was recently published in the journal BMJ Open, an open access, multidisciplinary medical journal.

Chiropractic is a health care profession that focuses on treatment of musculoskeletal conditions such as low back and neck pain. The most common therapy that chiropractors use is spinal manipulation, which includes a range of hands-on treatments directed to the joints of the spine. While chiropractic spinal manipulation has been found to be effective for treating low back pain, there has been limited research that explores whether this treatment is associated with a reduction in spine surgery.

In this retrospective cohort study, the authors selected adult patients, age 18 to 49, from a 101 million patient United States health records network (TriNetX, Cambridge, MA, USA), including data from 2012 to 2022. Patients with serious pathology or urgent indications for surgery were excluded from the study. Ultimately, the authors identified 5,785 patients who initially received chiropractic spinal manipulative therapy, and the same number of patients who received other forms of medical care for their low back pain. The authors used a statistical technique called propensity score matching to control for variables that could influence the likelihood that patients would undergo discectomy. In this process, they matched patients in both cohorts according to several such as age, sex, obesity, smoking, previous injections, and medications.

The authors found that patients who initially received chiropractic spinal manipulation for their low back pain were significantly less likely to undergo lumbar discectomy through two years’ follow-up.

  • At one year follow-up, 1.5% of the patients in the chiropractic cohort had undergone discectomy, compared to 2.2% of patients in the cohort receiving other care
  • At two years’ follow-up, 1.9% of the patients in the chiropractic cohort had undergone discectomy, compared to 2.4% of patients in the cohort receiving other care

This study builds on previous work that explored the relationship between chiropractic and surgery. Specifically, the authors examined a more specific population of low back pain, and a more specific outcome of discectomy. It represents the first study to examine whether chiropractic care is associated with a reduction in likelihood of discectomy. While the finding that chiropractic spinal manipulation is associated with a reduced likelihood of discectomy is promising, the study design was observational and included real-world data. Accordingly, there are certain limitations to the study findings. The authors recommended that their study be replicated using a randomized, controlled trial design.

The lead author, Robert J. Trager, is a chiropractic physician at Connor Whole Health, University Hospitals, where he frequently sees patients for low back pain. Through collaboration and mentorship from the research director of Connor Whole Health, Jeffery A. Dusek, the two have been investigating a series of outcomes related to chiropractic care, such as imaging use, medication use, and now surgery. Through their efforts, University Hospitals has become a leading institution in chiropractic research worldwide, per Expertscape, Inc. The team aims to continue their research on the topic of health service utilization as well as expand into other study designs.

You can read “Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States’ data” by clicking here.


About UH Connor Whole Health

UH Connor Whole Health is part of University Hospitals (UH), a comprehensive health system with annual revenues in excess of $5.0 billion, 23 hospitals (including 5 joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices located throughout 16 counties. UH’s goal is to be the most trusted health care partner in Northeast Ohio and UH Connor Whole Health furthers this objective by working to strengthen relationships between patients and providers to improve outcomes. The Whole Health approach prioritizes compassionate care centered on the patient’s entire well-being. The health care provider’s goal is to equip and empower each patient to take charge of their physical, mental, and spiritual health in order to live a full and meaningful life. Linking the patient’s larger purpose and life goals to their lifestyle allows clinical services, integrative medicine, and well-being programs to be delivered in a way that increases collaboration, motivation, and adherence to self-care and clinical needs. UH Connor Whole Health services include acupuncture, art therapy, chiropractic, expressive therapy (art, dance, and music), guided imagery, integrative medicine/lifestyle medicine consultations (adult and pediatric), massage therapy, meditation, mindfulness, osteopathic sports rehabilitation, stress management and resilience training workshops and yoga. For more information, visit UH Follow UH Connor Whole Health on LinkedIn.

About University Hospitals / Cleveland, Ohio
Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 23 hospitals (including 5 joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University and the Technion Israel Institute of Technology. The main campus also includes the UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit


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