Abstract
The aim of this systematic review was to summarize the evidence about the risks of
spinal manipulation. Articles were located through searching three electronic databases
(MEDLINE, EMBASE, Cochrane Library), contacting experts (n =9), scanning reference
lists of relevant articles, and searching departmental files. Reports in any language
containing data relating to risks associated with spinal manipulation were included,
irrespective of the profession of the therapist. Where available, systematic reviews
were used as the basis of this article. All papers were evaluated independently by
the authors. Data from prospective studies suggest that minor, transient adverse events
occur in approximately half of all patients receiving spinal manipulation. The most
common serious adverse events are vertebrobasilar accidents, disk herniation, and
cauda equina syndrome. Estimates of the incidence of serious complications range from
1 per 2 million manipulations to 1 per 400,000. Given the popularity of spinal manipulation,
its safety requires rigorous investigation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Dictionary of Alternative Medicine. Appleton and Lange, Stamford, CT1998
- Experts’ opinions on complementary/alternative therapies for low back pain.J Manipulative Physiol Ther. 1999; 22: 87-90
- Chiropractic for low back pain.BMJ. 1998; 317: 160
- The effectiveness of chiropractic for treatment of low back pain.J Manipulative Physiol Ther. 1996; 19: 499-507
- The outcome and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopaedic surgeons.N Engl J Med. 1995; 333: 913-917
- Prevalence of use of complementary/alternative medicine.Bull World Health Organ. 2000; 78: 252-257
- Prospective investigations into the safety of spinal manipulation.J Pain Symptom Manage. 2001; 21: 238-242
- Frequency and characteristics of side effects of spinal manipulative therapy.Spine. 1997; 22: 435-441
- Side effects of chiropractic treatment.J Manipulative Physiol Ther. 1997; 20: 511-515
- Adverse effects of spinal manipulation.J Roy Soc Med. 2000; 93: 258-259
- Complications of spinal manipulation.J Fam Pract. 1996; 42: 475-480
- Vertebrobasilar ischemia after neck motion.Stroke. 1991; 22: 1452-1460
- Manipulation of the cervical spine.Phys Ther. 1999; 79: 50-65
- Vascular complication involving the conus medullaris or cauda equina after vertebral manipulation for an L4-L5 disk herniation.Rev Rhum. 1998; 65: 279-282
- Brown-Séquard syndrome of the cervical spinal cord after chiropractic manipulation.Am J Neuroradiol. 1998; 19: 1349-1352
- Sudden onset vomiting and vertigo following chiropractic neck manipulation.J Postgrad Med. 1998; 74: 567-568
- The neurological complications caused by manual therapy in spinal osteochondrosis.Likarska Sprava. 1999; 6: 79-82
- Spinal manipulation—treatment associated with a high risk of complications.Lakartidningen. 1999; 96 ([in Swedish]): 3536-3540
- Stroke following chiropractic manipulation of the cervical spine.J Neurol. 1999; 246: 683-688
- Cerebral polyopia with extrastriate quadrantanopia.J Neuroophthalmol. 1999; 19: 1-6
- Serious complications with neck manipulation and informed consent.Med J Aust. 2000; 173: 213-214
- Consequences of neck manipulation performed by a non-professional.Spinal Cord. 2001; 39: 112-113
- Vertebral artery dissection and pontine infarction after chiropractic manipulation.Am J Emerg Med. 2001; 19: 172-173
- Doppelseitige dissektionen der vertebralarterien nach chiropraktischer behandllung der halswirbelsäule.Akt Neurologie. 1999; 26: 35-39
- Fatal outcome during physiotherapy (Vojta’s method) in a 3-month-old infant. Case report and comments on manual therapy in children.Klin Paediatr. 2001; 213 ([in German]): 76-85
- Vertebral artery dissection following chiropractic manipulation.Am J Emerg Med. 1998; 166: 207-210
- Thoracic epidural hematoma after spinal manipulation therapy.J Spinal Disord. 1999; 12: 534-536
- Vertebral and carotid artery dissection following chiropractic cervical manipulation.Neurosurg Rev. 1999; 22: 127-129
- Neuro-ophthalmologic complications of cervical manipulation.J Neuroophthalmol. 2000; 20: 236-239
- Stroke following chiropractic manipulation.J Neuroimaging. 2000; 10: 52
- Spontaneous vertebral arteriovenous fistula—case report.Neurol Med Chir (Tokyo). 2000; 40: 211-255
- More complications of spinal manipulation.Stroke. 2001; 32: 1136-1137
- Non-cerebrovascular complication in chirotherapy manipulation of the cervical vertebrae.Z Orthop Ihre Grenzgeb. 2001; 139 ([in German]): 8-11
- Horner’s syndrome and dissection of the internal carotid artery after chiropractic manipulation of the neck.Am J Ophthalmol. 2001; 131: 523-524
- Diaphragmatic paralysis following cervical chiropractic manipulation.Complement/Alt Med Asthma. 2001; 119: 638-640
- Neurologic complications following chiropractic manipulation.Neurology. 1995; 45: 1213-1215
- Incidence of neurological injury following neck manipulation.Irish Med J. 1998; 91: 130-132
- Neurological complications of cervical spine manipulation.J Roy Soc Med. 2001; 94: 107-110
- Komplikationen bei manueller therapie der halswirbelsaeule.Manuelle Medizin. 1978; 16: 77-81
- Cervical manipulation.JAMA. 1981; 245: 922-925
- A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain.Neurosurgery. 1993; 33: 73-78
- How dangerous is manipulation of the cervical spine? Case report and results of a survey.Manual Med. 1985; 2: 1-4
- Safety in chiropractic practice. Part I. The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978-1988.J Manipulative Physiol Ther. 1996; 19: 371-377
- A risk assessment of cervical manipulation vs NSAIDs for the treatment of neck pain.J Manipulative Physiol Ther. 1995; 18: 530-536
- Chiropractic manipulation and stroke.Stroke. 2001; 32: 1054-1060
- Cervical manipulation: is it really safe.Int J Risk Safety Med. 1994; 6: 145-149
- Vertebral artery dissection.Can J Neurol Sci. 2000; 27: 292-296
- Manipulation and mobilization of the cervical spine.Spine. 1996; 21: 1746-1759
- Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation.Spine. 1999; 24: 785-794
- Cervical spine manipulation and the precautionary principle.Joint Bone Spine. 2000; 67: 272-276
- Chiropractors’ use of X-rays.Br J Radiol. 1998; 71: 249-251
- Rise in popularity of complementary and alternative medicine.Vaccine. 2001; 20: S90-S93
- Informed consent in complementary and alternative medicine.Arch Intern Med. 2001; 161: 2288-2292
Article info
Publication history
Accepted:
January 15,
2002
Received in revised form:
December 17,
2001
Received:
June 29,
2001
Identification
Copyright
© 2002 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
