[Cervical spine manipulation: risks--benefit--assessment]

Cervical manipulation is a widely used method indicated in non-specific mechanical neck pain and cervicogenic headache. Cervical manipulation can cause severe neurologic complications which are both rare and generally unpredictable, which can be compared with the accidents occurring with other treatments (nonsteroidal anti-inflammatory drugs...). To decrease this risk, we propose five recommendations developed by consensus: --unwanted effects, however minor (e.g. nausea or vertigo), of prior manipulation should be searched for routinely and taken as contraindications for future spinal manipulations; --a thorough physical examination, including a neurological evaluation should be performed prior to manipulation; --all know indications and contraindications should be followed; -- manipulations should be performed only by physicians experienced in this technique; --special caution should be exercised when performing first-line cervical manipulation and simple, honest and easily understandable information about these risks should be included when informed consent is obtained.