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Adverse effects of spinal manipulation: a systematic review
1Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK. Edzard.Ernst@pms.ac.uk
Journal of the Royal Society of Medicine
|July 4, 2007
Summary
Spinal manipulation frequently causes mild adverse effects, and serious complications like vertebral artery dissection can occur. Patient safety necessitates reconsidering routine spinal manipulation use due to these risks.
Area of Science:
- Integrative medicine
- Neurology
- Public health
Background:
- Spinal manipulation is a common therapeutic intervention.
- Concerns exist regarding its potential adverse effects.
- Understanding these risks is crucial for patient safety.
Purpose of the Study:
- To systematically review and identify adverse effects associated with spinal manipulation.
- To assess the frequency and severity of these adverse events.
- To inform clinical practice and patient safety guidelines.
Main Methods:
- Systematic review of literature published between January 2001 and June 2006.
- Searches conducted across six electronic databases.
- Inclusion of case reports, case series, prospective series, case-control studies, and surveys.
Main Results:
- Over 200 patients reported serious harm in case reports/series, with vertebral artery dissection being common.
- Mild adverse effects reported in 30-61% of patients in prospective studies.
- Case-control studies suggested a causal link; surveys indicated underreporting of serious adverse events.
Conclusions:
- Spinal manipulation, especially on the upper spine, is linked to frequent mild/moderate adverse effects.
- Serious complications, including vertebral artery dissection and stroke, can occur.
- The exact incidence of serious adverse events is unknown, warranting a reevaluation of routine spinal manipulation use.
