March 13, 2014 — More than 100 chiropractors from the Netherlands, Belgium, and around Europe convened with other healthcare providers for a Day of the Spine Conference in Antwerp, March 1, 2014.
Co-sponsored by the European Chiropractors Union, the Belgian Chiropractors Union, and the Netherlands Chiropractic Association, the conference was hosted by the non-profit International Spine Research (INSPIRE) Foundation who has hosted similar events around the world as part of its mission. INSPIRE Directors included Chris Colloca, DC; Robert Gunzburg, MD, PhD; and Marek Szpalski, MD.
The multidisciplinary faculty for the Day of the Spine brought together different perspectives in patient management and the evidence base from basic sciences and clinical outcome studies (Table 1). Colloca opened the meeting with a welcome and review of the foundation’s mission before introducing the day’s agenda.
Belgian chiropractor, Luc Ailliet, DC, who is finishing his PhD at the University of Amsterdam, gave an informed lecture on the evidence base of spinal manipulation highlighting the systematic reviews and meta-analyses that are prominent today and were non-existent just 25 years ago. Tammy Rubinstein de Koekkoek, DC, provided her perspectives of evidence-based practice and multi-disciplinary practice guidelines that will help chiropractic’s integration into the healthcare system in Belgium and the Netherlands.
The morning session continued with lectures from Teddy Oosterhuis, MSc, who shared her PhD work into the effectiveness of rehabilitation after discectomy. While promising, a lack of evidence in the research base was identified with a need for more randomized controlled trials to improve the evidence base. Alan Breen, DC, PhD, from the Anglo-European Chiropractic College provided insights into his latest research into measuring vertebral motions using video floursosopy.
Neurosurgeon and epidemiologist, Wilco Peul, MD, PhD, from the University of Leiden offered the latest statistics on international variations in spinal surgery indicating up to a ten-fold variation between western nations. The U.S. had the highest back surgery rates, while the UK had one of the lowest. A relationship was found among the population of population of spine surgeons and the incidence of back surgery.
Peul went on to present his recently published randomized controlled clinical trials published in the New England Journal of Medicine and British Medical Journal that evaluated outcomes in patients with chronic sciatica having spinal surgery early or having prolonged conservative care. In nearly 300 participants in the trial, 141 had early surgery, within two weeks of their presentation to the surgeon, and 142 who received conservative care for 15 weeks prior to having surgery.
The significant benefit in pain relief and functional improvement that was observed in the early surgery group within the first six months was found to be short-lived as when compared to those having prolonged conservative treatment there was no difference in outcome at six months, one year, or two years of delaying surgery.
Local spine surgeons from Belgium, Robert Gunzburg, MD, and Marek Szpalski, MD, and deputy editors from the European Spine Journal, presented the group with indications for spine surgery and an update on the latest advances in new technologies in spinal surgery. Failure rates of disc replacements and other implanted devices were presented demonstrating their ineffectiveness. Szpalski stated, “Spine surgery seems to stimulate creative skills of surgeons and engineers more than any other field of orthopedic surgery, however may promising ideas on paper become major disappointments in practice.”
Colloca presented an overview of the research that he and his multidisciplinary team have conducted over the past 15 years culminating in more than 50 scientific journal articles. In this work, new techniques have been validated to quantify the dynamic stiffness of the spine and this information used as an objective biomechanical outcome measure to evaluate the effectiveness of chiropractic treatments. New medical devices have been made available for computer-aided spinal manipulation (and chiropractic adjustments) that control the force and frequency of thrusts providing repeatable forces that target the spine’s resonant frequency for more efficient treatments.
Following the eight scientific sessions, a panel discussion was held on the topic of medical and chiropractic perspectives surrounding the development and establishment of the chiropractic profession in Europe. Of the INSPIRE course’s benefit, Belgian Chiropractors’ Union Vice President, Bart Vandendries stated, “Big things happen from small starting places.”
Future INSPIRE Conferences will be held in Europe and other parts of the world.