The difference between the chiropractic and the medical approaches to health care
is never more apparent than with their treatment of radiculopathy.
The medical approach entails their version of “conservative” treatment, including pain medications, prolonged spinal injections, or perhaps a prescription for physical therapy. Then, if their “conservative” treatment does not alleviate the pain, decompressive surgery, such as laminectomy and/or discectomy/microdiscectomy, may be recommended.
Chiropractors aptly describe radiculopathy as “nerve root irritation”, and the chiropractic approach for resolution is quite straightforward.
Answer me this: If you have a rock in your shoe, and your foot hurts... do you need physical therapy, medications, or spinal injections? NO!!! You want your doctor (who is supposed to be the Sherlock Holmes of spinal diagnosis) to determine the CAUSE of the nerve root irritation (the rock), and to remove that obstacle from your path, so you may return to health.
Review the rest of this page to explore the real differences between these 2 approaches
to health care, and the difference in their success rates. The conclusions will surprise you!
Radiculopathy is characterized by motor and/or sensory changes in the neck and arms or the legs and feet, which results from extrinsic pressure on the nerve root. This pressure is typically caused by disc material, swelling, or osteophytes. A large study in Rochester, Minnesota, has reported the annual incidence of cervical radicular symptoms to be 83.2 per 100,000 population, and its prevalence most significant within a 50- to 54-year age group. In the study, 90 percent of patients were asymptomatic or only mildly incapacitated. Surgery is not often required for resolution of cervical radiculopathy symptoms.
Radicular pain, the characteristic symptom of cervical radiculopathy, is often confused with radiating pain in clinical practice. Because specific treatments are exclusively indicated for radicular pain, an accurate distinction is important. True radicular pain follows dermatomal patterns and is usually — though not always — unilateral. Onset is often insidious but may also be abrupt, and the pain is frequently aggravated by arm position and extension or lateral rotation of the head. 
There are three primary types of pain:
- Local Pain is caused by irritation to the structures in the back including bone, muscles, ligaments and joints. The pain is usually steady, sharp or dull, felt in the effected area of the spine and may change with changes in position or activity.
- Referred Pain can be pain caused by non-spinal pathology that is referred to the back, such as an abdominal aortic aneurysm. Referred pain can also be pain originating in the spine that is felt in distant structures. For instance upper lumbar pain is frequently felt in the upper thighs, and lower lumbar pain is felt in the lower buttocks. Sacroiliac joint pain is often referred to the inguinal and antero-lateral thigh area. Referred pain rarely extends below the knees, where as nerve root pain can be felt in the calf or foot.
- Radicular Pain is caused by irritation of the nerve roots (radix) and is usually more severe than referred pain, and may have a more distal radiation. Radicular pain usually circumscribes the territory of innervation of the given nerve root (in a dermatomal distribution). This type of pain is often deep and steady, and can usually be reproduced with certain activities and positions, such as sitting or walking.  In addition, radicular pain is frequently exacerbated by any maneuver that raises the pressure of cerebrospinal fluid (or the interabdominal pressure), such as valsalva, sneezing, or cough. 
Radicular Pain Distribution
Radicular pain radiates into the extremity (thigh, calf, and occasionally the foot or to the arm, forearm or hand) directly along the course of a specific spinal nerve root. The most common symptom of radicular pain is sciatica (pain that radiates along the sciatic nerve – down the back of the thigh and calf into the foot) and arm pain and paresthesia of the hand. Sciatica is one of the most common forms of pain caused by compression of a spinal nerve in the low back. It may result from compression of the lower spinal nerve roots (L5 and S1). With this condition, the leg pain is typically much worse than the low back pain, and the specific areas of the leg and/or foot that are affected depends on which nerve in the low back is affected. Compression of higher lumbar nerve roots such as L2, L3 and L4 can cause radicular pain into the front of the thigh and the shin.
The Diagnosis of Radicular Pain
Radiculopathy is caused by compression, inflammation and/or injury to a spinal nerve root,
typically within the vertebral foramina.
Causes of Radicular Pain, in their order of prevalence, include:
- Herniated disc with nerve compression – by far the most common cause of radiculopathy
- Foraminal stenosis (narrowing of the hole through which the spinal nerve exits due
to bone spurs or arthritis) – more common in elderly adults
- Nerve root injuries (Traction injuries and Whiplash injuries)
- Scar tissue from previous spinal surgery that is affecting the nerve root 
- Herpes Simplex Virus Type I Infection 
The cascade of events leading to radicular pain:
Thanks to the University of Pennsylvania for access to this slide!
The Treatment of Radicular Pain: The Medical Approach
It is usually recommended that a course of conservative treatment (such as physical therapy, medications, and selective spinal injections, among others) should be conducted for six to eight weeks. If conservative treatment does not alleviate the pain, decompressive surgery, such as laminectomy and/or discectomy/microdiscectomy, may be recommended. For patients with severe leg pain or other serious symptoms such as progressive muscle weakness, this type of surgery may be recommended prior to six weeks of non-surgical treatment. Back surgery for relief of radicular pain (leg pain) is much more reliable than for relief of low back pain.
Recent testing has demonstrated that treatment with Steroids offer no benefit compared with bupivacaine alone in chronic radicular pain.  Multiple adverse effects have been associated with prolonged steroid use, including suppression of the hypothalamic-pituitary-adrenal axis, immunosuppression, psuedotumor cerebri and psychoses, cataracts and increased intraocular pressure, osteoporosis, aseptic necrosis, gastric ulcers, fluid and electrolyte disturbances and hypertension, and impaired wound healing. 
Several surgical websites claim that surgery provides relief of radicular pain/leg pain for 83% to 90% of patients.
However, review of numerous peer-reviewed studies reveals that this is NOT the case.
Health Maintenance Care in Work-Related Low Back Pain
and Its Association With Disability Recurrence
Journal of Occupational and Environmental Medicine 2011 (Apr); 53 (4): 396–404
Medical researchers at the University of Massachusetts compared the health outcomes and/or disability episodes of patients with work-related low back pain, depending on what type of provider they saw. They focused primarily on MD (medical physician), PT (physical therapist), and DC (chiropractor) care.
The disability statistics were quite interesting:
For PTs:HR = 2.0
For MDs:HR = 1.6
For DCs:HR = 1.0
Statistically, this means you are twice as likely to end up disabled if you got your care from a PT, rather than from a chiropractor.
You’re also 60% more likely to be disabled if you choose an MD to manage your care, rather than a chiropractor.
The medical authors concluded:
“In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than with chiropractic services or no treatment”.
Long-term Outcomes of Lumbar Fusion Among Workers’
Compensation Subjects: An Historical Cohort Study
SPINE (Phila Pa 1976) 2011 (Feb 15); 36 (4): 320–331
Researchers (from the Division of Epidemiology and Biostatistics, Department of Environmental Health, at the University of Cincinnati College of Medicine) reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.
Even after two years, only 26 percent of those who had surgery had actually returned to work. That’s compared to 67 percent of patients who didn’t have the surgery, even though they had the same exact diagnosis!
In another troubling finding, the researchers determined that there was a 41 percent increase in the use of painkillers, particularly opiates, in those who had the surgery. Last year we reported that deaths from addictive painkillers has doubled in the last 10 years.
Money and Spinal Surgery: What Happened to the Patient?
Journal of the American Medical Association 2010 (Apr 7); 303 (13): 1259–1265
There is a lack of evidence-based support for the efficacy of complex fusion surgeries over conservative surgical decompression for elderly stenosis patients. There is, however, a significant financial incentive to both hospitals and surgeons to perform the complex fusions. Spinal stenosis is the most frequent cause for spinal surgery in the elderly. There has been a slight decrease in these surgeries between 2002 and 2007. However, there has also been an overall 15 fold increase in the more complex spinal fusions (360 degree spine fusions). Deyo et. al. in yesterday’s issue (April 7, 2010) of the Journal of the American Medical Association concludes that “It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years. The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications…financial incentives to hospitals and surgeons for more complex procedures may play a role…” There is a significant difference in mean hospital costs for simple decompression versus complex surgical fusion. The cost of decompression is $23,724 compared to an average of $80,888 for complex fusion. Despite the much higher cost, there is no evidence of superior outcomes and there is greater morbidity associated with the complex fusion. The surgeon is typically reimbursed only $600 to $800 for simple decompression and approximately ten times more, $6,000 to $8,000 for the complex fusion.
In a JAMA editorial that accompanied this study and was written by Dr. Carragee of Stanford University School of Medicine, the following comment was made “In 2007, the final year of data reported in the study by Deyo et al, Consumer Reports rated spinal surgery as number 1 on its list of overused tests and treatments. This was a harsh rebuke given the benefit associated with many common spinal surgeries. However, the findings from the study by Deyo et al should not only remind patients, surgeons, and payors that the efficacy of basic spinal techniques must be assessed carefully against the plethora of unproven but financially attractive alternatives, but also should serve as an important reminder that as currently configured, financial incentives and market forces do not favor this careful assessment before technologies are widely adopted. When applied broadly across medical care in the United States, the result is a formidable economic and social problem.”
“It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years. The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications… financial incentives to hospitals and surgeons for more complex procedures may play a role…” There is a significant difference in mean hospital costs for simple decompression versus complex surgical fusion.
The cost of decompression is $23,724 compared to an average of $80,888 for complex fusion.
It's not so hard to figure out why there has been a 15-fold increase in this specific surgery, when you look at the bottom line. Cui bono? Follow the Money!
Failed Back Surgery Syndrome: Diagnostic Evaluation
J Am Acad Orthop Surg 2006 (Sep); 14 (9): 534–543
Failed back surgery syndrome is a common problem with enormous costs to patients, insurers, and society. The etiology of failed back surgery can be poor patient selection, incorrect diagnosis, suboptimal selection of surgery, poor technique, failure to achieve surgical goals, and/or recurrent pathology. Successful intervention in this difficult patient population requires a detailed history, precise physical examination, and carefully chosen diagnostic tests. The diagnostic evaluation should endeavor to accurately identify symptoms, rule out extraspinal causes, identify a specific spinal etiology, and assess the psychological state of the patient. Only after these factors have been assessed can further treatment be planned.