Does Acupuncture Mean Fewer Back Surgeries?

Key points in 30 seconds

1. In Korean national health insurance data, the acupuncture group had about a 37% lower risk of back surgery.
2. It's a large dataset comparing about 130,000 people in each group, matched for similar conditions.
3. But it doesn't mean acupuncture prevents surgery.
4. You can take it to mean there's something worth trying before deciding on surgery.
5. If your legs feel weak or you have trouble controlling your bladder or bowels, talk to a surgeon first.

References — Koh W, et al. Effect of acupuncture on lumbar surgery rate
in patients with low back pain: A retrospective cohort study.
PLOS ONE. 2018;13(6):e0199042. DOI 10.1371/journal.pone.0199042

What we often hear

• "I was told I need surgery, and I'm scared."
• "If I get acupuncture, does that mean I won't need surgery?"
• "One place tells me to have surgery, and another tells me to wait it out."

Does acupuncture mean fewer back surgeries?

A study analyzing Korean national health insurance data found that people who received acupuncture had about a 37% lower risk of lumbar spine surgery. But this doesn't mean acupuncture prevents surgery; it means that when the two groups were followed, this difference showed up.

Surgery is the biggest worry for people who come to us with back pain. So this question needs an evidence-based answer. As it happens, there's a large dataset on patients in Korea.

What kind of study is it?

It used Korean national health insurance claims data. People newly diagnosed with low back pain were split into those who received acupuncture and those who didn't, then people with similar conditions were paired up, comparing about 130,000 people in each group.

The pairing process matters. Without matching for things like age, sex, and other illnesses, you'd be comparing different kinds of people from the start. This study went through that process.

Here's what it found. During the follow-up period, 701 people in the acupuncture group and 1,104 people in the comparison group had lumbar spine surgery. As rates, that's 0.54% and 0.85%.

Study	Design	Participants	Main results	Level of evidence
Koh 2018
PLOS ONE 13(6):e0199042
DOI 10.1371/journal.pone.0199042	Retrospective cohort
Korean national health insurance claims data
Propensity score matching	130,089 per group
New low back pain patients, 2004–2010	Lumbar surgery rate 0.54% vs 0.85%
37% lower surgery risk
HR 0.633 (95% CI 0.576–0.696)	High
Korean data

How far should we trust this number?

This study didn't randomly divide people and give acupuncture to only one side. It looked back at records of people who had already chosen their own treatment, so we can't say for certain that acupuncture reduced surgery.

Here are the limits in detail. First, people who sought out acupuncture may differ from those who didn't. Their symptoms may have been milder, or they may have been more reluctant to have surgery. Even with matching, differences that aren't in the records can't be matched.

Second, this data comes from claims records. It doesn't include which acupuncture points were used, how many times, or how much the pain decreased. Third, having less surgery doesn't mean things went better. Some cases may include people who put off surgery they really needed.

So what do you tell patients in the clinic?

We don't tell you that you can avoid surgery. Instead, we tell you there are things you can try before deciding on surgery, and there's data suggesting that choice wasn't a bad one.

There are definitely cases where surgery is needed. If your legs lose strength, you have trouble controlling your bladder or bowels, or the pain suddenly gets much worse, we recommend a surgical consultation without delay. This column is about people who aren't in that situation.

We start counting again from the moment you were told about surgery. If we measure how far you can walk now and how strong your legs are, we can set in numbers how long to try treatment.

If you've been advised to have surgery and can't decide, come see us. We're not here to tell you to avoid it; we want you to check what needs checking before you decide.

Even with the same treatment, results differ from person to person depending on the condition of the back and how long it has been going on.