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.

PCA Strategic Business Partner Spotlight: Praxi AI

In this episode of the PCA Spinal Chat Podcast, Executive Director Mike Barba hosts Andre Jones from Praxi AI to explore how their AI technology can transform chiropractic practices. They discuss in detail how Praxi AI can improve office efficiency, reduce missed calls, boost patient satisfaction, and free up staff time for more value-added activities. Andre explains Praxi AI’s seamless integration, customizable features, and measurable ROI. He also addresses common questions about HIPAA compliance and brand integration, emphasizing the importance of safeguarding patient information while maintaining a practice’s unique voice. The episode includes a live demo of Praxi AI’s advanced capabilities, including appointment scheduling, language adaptability, and 24/7 support, highlighting its potential to revolutionize practice management in the chiropractic field.

00:00 Introduction to PCA Spinal Chat Podcast

00:34 Meet Praxi AI and Andre Jones

01:41 Understanding Praxi AI's Unique Approach

04:05 Praxi AI's Integration and Customization

05:10 Live Demo of Praxi AI

05:54 Challenges in Chiropractic Practices

07:25 The Business Case for AI in Healthcare

10:10 Praxi AI's Key Features and Benefits

13:50 Measurable ROI and Analytics

15:38 HIPAA Compliance and Brand Integration

21:39 Language Support and Subscription Details

24:08 Live Call Demo and Final Thoughts

29:59 Conclusion and Closing Remarks

Praxi AI: http://www.praxiai.com/

Discount Code: PCA

Andre Jones Email: info@praxiai.com

PCA Website: https://pennchiro.org/

PCA Email: pca@pennchiro.org

PCA Audio Newsletter: October’s Key Updates and Announcements

In the October 2025 edition of the PCA Spinal Chat Audio Newsletter, the Pennsylvania Chiropractic Association highlights legislative advances, member achievements, new educational offerings, and updates shaping chiropractic's future in Pennsylvania. This episode features messages from Executive Director Mike Barba, PCA President Dr. Andrew Heck, Vice President Dr. Kris Arnold, and Treasurer Dr. Theresa Russo. Key topics include the recent success at the Northeast Chiro Summit, the launch of the state's first chiropractic apprenticeship pathway, progress in legislative advocacy, and enhancements to member benefits. Additionally, the episode promotes the 2026 Northeast Chiro Summit, announces new continuing education opportunities, and highlights partnerships with various business members. Listeners are encouraged to support legislative initiatives like H.R. 539 to enhance patient access to chiropractic care.

00:00 Welcome to the PCA Spinal Chat Audio Newsletter

00:44 Annual Address and Year in Review

03:28 Maximizing Your PCA Membership

08:26 Financial Transparency and Sustainability

11:42 President's Annual Address

17:49 Federal Advocacy and Legislative Updates

20:01 Northeast Chiro Summit 2026

21:17 Member Spotlights and Business Partners

24:56 Insurance Hot Topics and CE Opportunities

27:09 Closing Remarks and Call to Action

Link to October Newsletter: https://www.flipsnack.com/8A598DCC5A8/october-2025-newsletter/full-view.html

PCA Website: https://pennchiro.org/

PCA Email: pca@pennchiro.org

The 41.2° Breakpoint: What X-rays Reveal About Acute Low Back Pain

Study Featured in This Episode

Sensitivity and Specificity of Elliptical Modeling and Sagittal Lumbar Alignment Variables in Normal vs. Acute Low Back Pain Patients: Does Pelvic Morphology Explain Group Lordotic Differences? Published in Healthcare (MDPI Multidisciplinary), 2025.

Full Article Link (Open Access): https://doi.org/10.3390/healthcare13233163

MDPI / Multidisciplinary Journal Homepage: https://www.mdpi.com/journal/healthcare

Author Credits (as required by MDPI)

• Paul A. Oakley, Independent Researcher, Canada
• Ibrahim M. Moustafa, College of Health Sciences, University of Sharjah, UAE
• Joseph W. Betz, Independent Researcher, Idaho, USA
• Jason O. Jaeger, Southern California University of Health Sciences
• Deed E. Harrison, Chiropractic Biophysics NonProfit, Inc. 00:00 Introduction to PCA Deep Dive00:26 Challenging Conventional Wisdom on X-rays01:52 Study Overview: Participants and Measurements05:17 Key Findings: Alignment vs. Structure08:30 Implications for Clinical Practice11:55 Conclusion and Final ThoughtsEpisode Summary

In this PCA Deep Dive, we examine a newly published MDPI Multidisciplinary study that challenges long-standing assumptions in acute low back pain management. Using standing radiographs from 100 participants, 50 healthy controls and 50 patients with first-episode acute mechanical LBP, the researchers investigated whether simple spinal alignment variables could objectively distinguish the two groups.

Their key finding: sacral base angle (SBA) and global lumbar lordosis (Cobb T12–S1) were significantly greater in the acute pain group, despite no differences in pelvic morphology. The SBA cut-off value of 41.2° demonstrated meaningful discriminative value (AUC 0.665; sensitivity 70%; specificity 62%).

The implication is clear: alignment, not structure, separates acute pain patients from healthy individuals, and routine imaging may offer clinically meaningful biomechanical clues during a first episode of low back pain. This study adds to the growing evidence challenging “no imaging” guidelines that rely on outdated radiological risk models.

We break down the methodology, biomechanical logic, statistical outcomes, and the provocative case the authors make regarding the limitations of the ALARA radiation principle.

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.

Faster Recovery, Lower Costs: Chiropractic’s Role in Workforce Health

Unlocking the Potential of Chiropractic Care in Workers’ Compensation

In this episode of the PCA Deep Dive Series by the Pennsylvania Chiropractic Association, we explore the significant impact of chiropractic care on low back pain within the workers' compensation (WC) system. With low back pain being the leading cause of disability worldwide, contributing to over $134 billion in U.S. healthcare costs annually, this episode delves into comprehensive data from the Workers’ Compensation Research Institute and a long-term study on a self-insured workforce. Key findings reveal that exclusive chiropractic care can substantially reduce overall medical costs, shorten disability duration, and decrease the necessity for high-risk services like MRIs and opioids. The episode also examines the influence of state policies on the prevalence of chiropractic care in WC systems and discusses strategies for policymakers and employers to identify which workers could benefit most from early chiropractic intervention.

00:00 Introduction to the PCA Deep Dive Series

00:15 Understanding the Impact of Low Back Pain

00:43 Data Sources and Real-World Outcomes

01:23 The Workers' Compensation System and Chiropractic Care

03:16 Recommended First Steps for Low Back Pain

04:13 Chiropractors vs. Physical Therapists

05:49 State Policies and Chiropractic Care Usage

07:38 Treatment Patterns and Patient Complexity

10:12 Exclusive Chiropractic Care: Cost and Recovery Benefits

12:45 Concluding Insights and Future Challenges

Workers’ Compensation Research Institute (WCRI)

Wang D, Mueller KL, Murphy DR, Lea RD. Chiropractic Care for Workers with Low Back Pain. WCRI, 2022. PDF: https://www.wcrinet.org/reports/chiropractic-care-for-workers-with-low-back-pain

Major Self-Insured Employer Study

Allen H, Wright M, Craig T, Mardekian J, Cheung R, Sanchez R, Bunn WB, Rogers W. Tracking Low Back Problems in a Major Self-Insured Workforce: Toward Improvement in the Patient’s Journey. Journal of Occupational & Environmental Medicine, 2014. 10.1097/JOM.0000000000000210

PCA Website: https://pennchiro.org/

Contact the PCA: 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.

Succession, Retirement, and Real Wealth Planning for Chiropractors with Prudential

In this episode of The Spinal Chat Podcast, powered by the Pennsylvania Chiropractic Association, host Mike Barba discusses financial planning, succession strategies, and long-term wealth management tailored explicitly for chiropractors. The special guests are Tom and Annette Quigley from Prudential, who share their expertise on business valuation, practice transition, insurance strategies, and personal financial health. They offer practical advice for chiropractors at various career stages, from those just starting to those nearing retirement. Key topics include maintaining financial stability amid transitions, retaining key staff, and balancing personal and business wealth. The episode highlights the importance of initiating financial planning early, tailoring strategies to individual needs, and considering tax implications to maximize long-term security. Check out the show notes for links to contact information, educational resources, and upcoming financial planning webinars with Prudential.

00:00 Introduction to The Spinal Chat Podcast

00:12 Meet Prudential: New Strategic Business Partner

00:38 Financial Challenges and Opportunities for Chiropractors

01:15 Introducing Tom and Annette from Prudential

01:35 Understanding Prudential's Role and Services

03:12 Planning for Retirement and Business Transition

04:26 Valuing Your Chiropractic Practice

08:30 Retaining and Rewarding Key Staff

12:35 Tax Strategies for Chiropractors

18:08 Personal and Professional Financial Planning

20:24 Insurance and Annuities for Long-Term Wealth

25:31 The Importance of Risk Management

29:02 Balancing Financial Health and Investments

29:44 Incremental Changes for Financial Growth

30:48 Importance of Early Financial Planning

31:48 Retirement Planning and Insurance

34:21 Real-Life Retirement Stories

38:17 Longevity Risk and Financial Planning

42:52 Investment Strategies for Different Life Stages

48:51 Net Worth vs. Cash Flow

50:36 Conclusion and Final Thoughts

YouTube Video: https://www.youtube.com/watch?v=seGQX4eLjHo&t=2s

Tom McElwee contact: Tom.McElwee@prudential.com

Mid-Atlantic Financial Group: https://midatlanticfg.com/about-us/

Anette Quigley contact: annette.quigley@prudential.com

Frame Partners: https://www.framewealth.com/

PCA Website: https://pennchiro.org/

Contact the PCA: pca@pennchiro.org