Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation

This single-blind randomised clinical trial compared osteopathic manipulati ve treatment with chemonucleolysis (used as a control of known efficacy) fo r symptomatic lumbar disc herniation. Forty patients with sciatica due to t his diagnosis (confirmed by imaging) were treated either by chemonucleolysi s or manipulation. Outcomes (leg pain, back pain and self-reported disabili ty) were measured at 2 weeks, 6 weeks and 12 months. The mean values for al l outcomes improved in both groups. By 12 months, there was no statisticall y significant difference in outcome between the treatments, but manipulatio n produced a statistically significant greater improvement for back pain an d disability in the first few weeks. A similar number from both groups requ ired additional orthopaedic intervention; there were no serious complicatio ns. Crude cost analysis suggested an overall financial advantage from manip ulation. Because osteopathic manipulation produced a 12-month outcome that was equivalent to chemonucleolysis, it can be considered as an option for t he treatment of symptomatic lumbar disc herniation, at least in the absence of clear indications for surgery. Further study into the value of manipula tion at a more acute stage is warranted.