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Adverse events associated with pediatric spinal manipulation: a systematic review
Sunita Vohra1, Bradley C Johnston, Kristie Cramer
1CARE Program, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada T6G 2E1. svohra@ualberta.ca
Pediatrics
|December 21, 2006
Summary
Pediatric spinal manipulation may lead to serious adverse events, including neurologic and musculoskeletal issues. More research is needed to understand the true incidence and risks of these events in children.
Area of Science:
- Pediatric medicine
- Manual therapy research
- Patient safety
Background:
- Spinal manipulation is a common manual therapy for children.
- Understanding pediatric risk estimates for spinal manipulation is limited.
Purpose of the Study:
- To systematically identify and synthesize data on adverse events linked to pediatric spinal manipulation.
Main Methods:
- Searched 8 electronic databases from inception to June 2004.
- Included primary investigations of spinal manipulation in patients aged 18 or younger.
- Focused on reporting the nature and severity of adverse events, not incidence.
Main Results:
- Identified 13 studies (2 randomized trials, 11 observational reports).
- Documented 14 direct adverse events (neurologic, musculoskeletal), including serious cases like subarachnoidal hemorrhage and paraplegia.
- Reported 20 indirect adverse events, such as delayed diagnoses and inappropriate use for serious conditions.
Conclusions:
- Serious adverse events are possible with pediatric spinal manipulation.
- Current observational data cannot establish causation or incidence rates.
- Prospective population-based surveillance is necessary to assess rare, serious adverse events.
