Single-blind Randomised Controlled Trial of Chemonucleolysis
and Manipulation in the Treatment of
Symptomatic Lumbar Disc Herniation

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   European Spine Journal 2000 (Jun);   9 (3):   202–207

A. K. Burton (1), K. Malcolm Tillotson (1), John Cleary (2)

(1) Spinal Research Unit, University of Huddersfield, 30 Queen Street, Huddersfield HD1 2SP, UK e-mail: kburton@cix.co.uk, Tel.: +44-1484-535200, Fax: +44-1484-435744 (2) Department of Orthopaedics, Huddersfield Royal Infirmary, Huddersfield, UK

Forty patients with confirmed sciatica were treated with either osteopathic manipulation treatment or chemonucleolysis. The pain endured by the patient was measured at 2 weeks, 6 weeks and one year. After a year patients from both groups were very similar in recovery. However, at 2 and 6 weeks those receiving manipulation reported greater improvement.

This single-blind randomised clinical trial compared osteopathic manipulative treatment with chemonucleolysis (used as a control of known efficacy) for symptomatic lumbar disc herniation. Forty patients with sciatica due to this diagnosis (confirmed by imaging) were treated either by chemonucleolysis or manipulation. Outcomes (leg pain, back pain and self-reported disability) were measured at 2 weeks, 6 weeks and 12 months. The mean values for all outcomes improved in both groups. By 12 months, there was no statistically significant difference in outcome between the treatments, but manipulation produced a statistically significant greater improvement for back pain and disability in the first few weeks. A similar number from both groups required additional orthopaedic intervention; there were no serious complications. Crude cost analysis suggested an overall financial advantage from manipulation. Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis, it can be considered as an option for the treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. Further study into the value of manipulation at a more acute stage is warranted.

Key words: Chemonucleolysis – Lumbar disc herniation – Manipulation – Osteopathy – Randomised controlled trial – Sciatica

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