{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:31:40Z","timestamp":1787567500982,"version":"build-2736575974"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lumbar disc herniation (LDH) commonly causes persistent pain, disability, and recurrence despite conservative care. Whether pelvic correction manipulation adds durable benefit to adjacent needling remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the association of adding pelvic correction manipulation to adjacent needling with disability, pain, and recurrence in LDH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center prospective comparative cohort study with retrospective long-term outcome ascertainment enrolled consecutive adults with symptomatic, imaging-confirmed LDH in Wuxi, China, from December 2019 to December 2020. Patients received adjacent needling plus pelvic correction manipulation or adjacent needling alone according to clinician\u2013patient choice. The primary outcome was change in Oswestry Disability Index (ODI) at treatment completion. Secondary outcomes included pain, Japanese Orthopedic Association score, ODI response, recurrence, and adverse events through 24 months. Baseline-adjusted mixed-effects models, propensity-score overlap weighting, multiple imputation, and sensitivity analyses were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 208 patients, 106 received combined therapy and 102 adjacent needling alone. Combined therapy was associated with greater ODI reduction at treatment completion (adjusted difference, \u22123.40 points; 95% CI, -5.40 to -1.40;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001) and at 24 months (\u22124.40; 95% CI, \u22127.30 to \u22121.50;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.003). At 24 months, \u226550% ODI improvement occurred in 58.9% versus 40.5% (adjusted RR, 1.41; 95% CI, 1.06\u20131.87), and recurrence in 23.6% versus 39.2% (adjusted HR, 0.55; 95% CI, 0.34\u20130.89). Exploratory alignment, mobility, and inflammatory findings also favored combined therapy. No serious treatment-related events occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adding pelvic correction manipulation was associated with modestly better long-term disability outcomes and lower recurrence, but randomized trials are needed to confirm causality. Because treatment was not randomized, these findings should be read as associations rather than proof of a causal effect, and unmeasured confounding cannot be excluded.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1936013","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:18:45Z","timestamp":1787563125000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical outcomes associated with adding pelvic correction manipulation to adjacent needling for lumbar disc herniation: a prospective comparative cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Cheng","family":"Li","sequence":"first","affiliation":[{"name":"Department of Acupuncture and Moxibustion, Affiliated Hospital of Jiangnan University, Wuxi","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Acupuncture and Moxibustion, Affiliated Hospital of Jiangnan University, Wuxi","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinfei","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Acupuncture and Moxibustion, Affiliated Hospital of Jiangnan University, Wuxi","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohua","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rehabilitation and Convalescence Center of the Joint Logistic Support Force of the Chinese People\u2019s Liberation Army","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinjian","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine, Guangyi Subdistrict Community Health Service Centre, Wuxi","place":["Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1007\/s00586-024-08528-8","article-title":"Incidence of and risk factors for lumbar disc herniation with radiculopathy in adults: a systematic review.","volume":"34","author":"Hincapi\u00e9","year":"2025","journal-title":"Eur Spine J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.spinee.2013.08.003","article-title":"An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy.","volume":"14","author":"Kreiner","year":"2014","journal-title":"Spine J"},{"key":"B3","volume-title":"WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care settings.","year":"2023"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e0322929","DOI":"10.1371\/journal.pone.0322929","article-title":"The effectiveness of non-pharmacological interventions for low back pain in China: a systematic review and network meta-analysis.","volume":"20","author":"Liu","year":"2025","journal-title":"PLoS One"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1001\/jamainternmed.2024.5463","article-title":"Acupuncture vs sham acupuncture for chronic sciatica from herniated disk: a randomized clinical trial.","volume":"184","author":"Tu","year":"2024","journal-title":"JAMA Intern Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1507115","DOI":"10.3389\/fmed.2024.1507115","article-title":"Comparative clinical efficacy of acupuncture combined with manipulation and other non-pharmacological interventions in the treatment of lumbar disc herniation: a prospective, multi-arm, randomized, open-label, blinded endpoint trial.","volume":"11","author":"Shi","year":"2025","journal-title":"Front Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1007\/s005860050038","article-title":"Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves.","volume":"7","author":"Legaye","year":"1998","journal-title":"Eur Spine J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1976","DOI":"10.1177\/21925682241274729","article-title":"Effect of paravertebral muscle degeneration on lumbar and pelvic sagittal alignment in patients with degenerative scoliosis.","volume":"15","author":"Liu","year":"2025","journal-title":"Global Spine J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3390\/jpm14010036","article-title":"Thoracolumbar\/lumbar degenerative kyphosis-the importance of thoracolumbar junction in sagittal alignment and balance.","volume":"14","author":"Liu","year":"2023","journal-title":"J Pers Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e1000261","DOI":"10.1371\/journal.pmed.1000261","article-title":"Revised STandards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement.","volume":"7","author":"MacPherson","year":"2010","journal-title":"PLoS Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The oswestry disability index.","volume":"25","author":"Fairbank","year":"2000","journal-title":"Spine."},{"key":"B13","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1097\/BRS.0b013e31815e3a10","article-title":"Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change.","volume":"33","author":"Ostelo","year":"2008","journal-title":"Spine"},{"key":"B14","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1023\/B:QURE.0000018486.91360.00","article-title":"The world health organization\u2019s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group.","volume":"13","author":"Skevington","year":"2004","journal-title":"Qual Life Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1097\/00007632-200109010-00011","article-title":"Magnetic resonance classification of lumbar intervertebral disc degeneration.","volume":"26","author":"Pfirrmann","year":"2001","journal-title":"Spine"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2417","DOI":"10.1001\/jama.2020.7819","article-title":"Overlap weighting: a propensity score method that mimics attributes of a randomized clinical trial.","volume":"323","author":"Thomas","year":"2020","journal-title":"JAMA"},{"key":"B17","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/sim.4067","article-title":"Multiple imputation using chained equations: issues and guidance for practice.","volume":"30","author":"White","year":"2011","journal-title":"Stat Med"},{"key":"B18","doi-asserted-by":"publisher","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value.","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1001\/jama.1983.03330370053031","article-title":"If nothing goes wrong, is everything all right? Interpreting zero numerators.","volume":"249","author":"Hanley","year":"1983","journal-title":"JAMA."},{"key":"B20","doi-asserted-by":"publisher","first-page":"393","DOI":"10.4103\/njcp.njcp_814_24","article-title":"Inflammatory and analgesic profiles in intervertebral disc herniation: variability with respect to neurological deficit.","volume":"28","author":"Morko\u00e7","year":"2025","journal-title":"Niger J Clin Pract"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1016\/j.spinee.2024.02.006","article-title":"Evidence of MRI image features and inflammatory biomarkers association with low back pain in patients with lumbar disc herniation.","volume":"24","author":"Chen","year":"2024","journal-title":"Spine J"},{"key":"B22","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1111\/jebm.12598","article-title":"An evidence-based guideline on treating lumbar disc herniation with traditional Chinese medicine.","volume":"17","author":"Qin","year":"2024","journal-title":"J Evid Based Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"277","DOI":"10.3233\/BMR-220347","article-title":"Huoxue Tongluo decoction combined with acupuncture in the treatment of lumbar disc herniation and its effect on JOA and VAS scores.","volume":"37","author":"Zhong","year":"2024","journal-title":"J Back Musculoskelet Rehabil"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.1097\/BRS.0b013e318183bb86","article-title":"Elevated levels of tumor necrosis factor-alpha in periradicular fat tissue in patients with radiculopathy from herniated disc.","volume":"33","author":"Genevay","year":"2008","journal-title":"Spine"},{"key":"B25","doi-asserted-by":"publisher","first-page":"112119","DOI":"10.1016\/j.exger.2023.112119","article-title":"The mechanisms and functions of TNF-\u03b1 in intervertebral disc degeneration.","volume":"174","author":"Pan","year":"2023","journal-title":"Exp Gerontol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1936013\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T09:18:47Z","timestamp":1787563127000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1936013\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":25,"alternative-id":["10.3389\/fmed.2026.1936013"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1936013","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"1936013"}}