Epidural Corticosteroids for Sciatica: More Trouble Than They're Worth

Staying with the topic of epidural steroid injections ( which again are not approved by the FDA), this is an article by a chiropractic radiologist.These injections give modest improvement for sciatica which is temporary and no improvement for back pain alone ( but are often given for this reason) and can have serious side effects. In spite of this, costs for this procedure have risen 629% in the last ten years!
Do you think epidurals or chiropractic care have better average insurance reimbursement?

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56985

Spinal manipulation more clinically effective and cost effective than lumbar epidural injection for MRI confirmed disc herniation

Staying with the comparative research line, this study from last year compared manipulation to lumbar epidural injection (again this procedure is not approved by the FDA) for MRI confirmed disc herniations. The manipulation group reported 77% improvement and the epidural injection group only 63% improvement. Also the manipulation group was an average of $200 less expensive.
Any surprises here?

http://www.ncbi.nlm.nih.gov/pubmed/23706678

Chiropractic maintenance treatment

I used to attend many health fairs and had many people tell me they heard that once you started chiropractic care you had to go the rest of your life, and even a few who thought you could get "addicted" to chiropractic treatment  
The reality is that just like dental care, there is a percentage of patients who choose to continue periodic care to either control the symptoms of a chronic condition or prevent future problems.
Here is a recent study showing that patients who continued periodic treatment for 9 months after active treatment actually gained additional improvement over that time.
Has anyone heard you had to go the rest of your life or you can get addicted to chiropractic?

http://www.ncbi.nlm.nih.gov/pubmed/21245790

Tapping into controversial back surgeries

This is a very good report from CBS News based on 6 months of research concerning a controversial type of spine surgery called spinal fusion. The website has both a video and text of the story. Although this procedure has good evidence of benefit for a few conditions such as instability and sciatica from stenosis or narrowing of the spine, most of the time it is done for conditions with much less evidence of efficacy such as disc degeneration. I have patients who have had fusions and it is usually more difficult to get them relief, especially when multiple segments were fused.
Has anyone had experience with this procedure?

http://www.cbsnews.com/news/tapping-into-controversial-back-surgeries/