PCA Deep Dive: One Surgery Rarely Stays One: What 308,000 Patients Reveal

This episode of PCA Deep Dive, presented by the Pennsylvania Chiropractic Association, examines the critical decisions patients face when dealing with severe low back pain. The discussion centers on the impact of choosing initial care providers—comparing conservative management (such as chiropractic care) with surgical pathways. Using data from key studies, including long-term outcomes of lumbar discectomies, the episode highlights how initial decisions influence long-term surgical risks, reoperation rates, and the overall durability of surgical interventions. The insightful analysis emphasizes the importance of sequencing, risk management, and understanding the broader implications of early healthcare choices on lifelong spine health.

00:00 Introduction to PCA Deep Dive

00:09 The Immediate Crisis of Severe Low Back Pain

00:20 The Impact of Initial Care on Long-Term Outcomes

01:08 Comparing Initial Provider Choices

01:52 Statistical Analysis of Surgical Risks

02:19 The Conservative Pathway vs. Surgical Pathway

06:04 Understanding Surgical Durability

08:31 Factors Influencing Surgical Outcomes

10:58 Implications for Patients and Healthcare Systems

14:28 Conclusion and Key Takeaways

Study Attribution & Source

This episode references findings from the following peer-reviewed study published in Spine:

Etigunta, S.K., Liu, A.M., Gausper, A., Chan, V., Scheer, J., Perry, T., Skaggs, D.L., Walker, C., & Tuchman, A. Long-Term Reoperation Rates After Single-Level Lumbar Discectomy: A Nationwide Cohort Study. Spine, Volume 50, Issue 15, August 1, 2025.

The study is a retrospective cohort analysis of 308,979 patients followed for at least 5 years, evaluating long-term reoperation and fusion rates following single-level lumbar discectomy.

Journal Link (DOI): https://doi.org/10.1097/BRS.0000000000005328

PCA Website: https://pennchiro.org/

PCA Email: pca@pennchiro.org

Disclosure

The Pennsylvania Chiropractic Association did not generate this data. PCA Deep Dive reviews and discusses independent, peer-reviewed research to translate long-term outcomes and clinical implications for patients, clinicians, policymakers, and healthcare decision-makers.

PCA Deep Dive: Beyond the Pain Score: What Really Prevents Chronic Back Pain

In this episode of the Deep Dive, the focus is on a newly published randomized clinical trial, the PACBACK trial, from The Journal of the American Medical Association. This study examines spinal manipulation and clinician-supported biopsychosocial self-management versus standard medical care in treating acute and subacute low back pain in patients at high risk of chronic disability. The trial's findings emphasize the importance of long-term function over short-term symptom relief, showcasing how conservative, nonpharmacologic approaches, particularly self-management strategies, lead to significant reductions in disability. The episode also delves into the methodologies and tools used in the study, such as the Start Back screening tool, the Wellbeing Wheel, and the Behavior Change Wheel, offering a comprehensive look at how these approaches can transform patient care in chiropractic and physical therapy.

00:00 Introduction to the Deep Dive

00:06 Overview of the PACBACK Trial

00:35 Significance of Low Back Pain

00:45 Study Design and Methodology

02:18 Detailed Breakdown of Study Groups

03:16 Results: Disability and Pain Outcomes

05:40 Mechanisms Behind Supported Self-Management

06:06 Practical Implementation and Skills Taught

08:25 Responder Analysis and Key Statistics

08:58 Comparing Spinal Manipulation Therapy

11:41 Policy Implications and Systemic Challenges

12:53 Study Limitations and Final Thoughts

14:15 Conclusion and Key Takeaways

Title: Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial

Published: JAMA, December 29, 2025

Authors: Gert Bronfort, PhD, DC Eric N. Meier, MS Brent Leininger, PhD, DC, MS Michael Schneider, PhD, DC Roni Evans, PhD, DC, MS Carol Greco, PhD Linda Hanson, DC, MS Christine McFarland, BS, BA Roger Chou, MD John Connett, PhD Anthony Delitto, PhD, PT Steven Z. George, PhD, PT Ronald M. Glick, MD Francis Keefe, PhD John Licciardone, DO, MS, MBA Craig Schulz, DC, MS Dennis Turk, PhD Patrick J. Heagerty, PhD, MS

Journal Reference: JAMA. 2025; Published online December 29, 2025.

DOI: 10.1001/jama.2025.21990

This episode references findings from the PACBACK Randomized Clinical Trial published in JAMA in December 2025 by Bronfort and colleagues.

PCA Website: https://pennchiro.org/

PCA Email: pca@pennchiro.org

Disclosure

The Pennsylvania Chiropractic Association did not generate this data. PCA Deep Dive reviews and discusses independent, peer-reviewed research to help translate long-term outcomes and clinical implications for patients, clinicians, policymakers, and healthcare decision makers.

Judge, Jury, and Insurer? The Geico No-Fault Wake-Up Call

This episode of PCA Deep Dive, a service of the Pennsylvania Chiropractic Association, explores the New York Court of Appeals decision in Geico v. Mayzenberg. This landmark case redefines the boundaries of authority between insurers and state regulators. It highlights the court's ruling that insurers cannot unilaterally deny claims based on suspected misconduct. Instead, such assessments must be made by state regulatory bodies like the New York State Board of Regents. The episode delves into the case specifics, legal strategies, and the broader implications for healthcare providers, insurance professionals, and the no-fault system. Despite potential new bottlenecks at the regulatory level, the ruling aims to protect due process and maintain the efficiency of accident victim compensation.

00:00 Introduction to PCA Deep Dive

00:13 Case Overview: Guyco v. Mayzenberg

01:25 The Alleged Scheme and Legal Strategy

04:02 Court's Ruling and Its Implications

04:32 The Role of State Regulators

10:10 Balancing Efficiency and Justice

11:44 Conclusion and Key Takeaways

13:12 Closing Remarks and Call to Action

PCA Website: https://pennchiro.org/

PCA Email: pca@pennchiro.org

Disclosure

The Pennsylvania Chiropractic Association did not generate this data. PCA Deep Dive reviews and discusses independent, peer-reviewed research to help translate long-term outcomes and clinical implications for patients, clinicians, policymakers, and healthcare decision makers.