Chiropractic Care and Spinal Manipulation: Evidence, Risks, and Referral Considerations for Spine Surgeons

Area of Science:

• Integrative Medicine
• Musculoskeletal Disorders
• Evidence-Based Practice

Background:

• Low back pain (LBP) is a prevalent condition with various treatment options.
• Spinal manipulation therapy (SMT) is a common conservative treatment approach.
• Understanding the efficacy and safety of SMT across different conditions is essential.

Purpose of the Study:

• To review the evidence supporting Spinal Manipulation Therapy (SMT) for Low Back Pain (LBP).
• To evaluate the role of SMT for conditions beyond LBP.
• To assess the risk profile and identify ongoing gaps in SMT research and practice.

Main Methods:

• Systematic review of existing evidence on SMT for various musculoskeletal conditions.
• Analysis of reported adverse events and contraindications associated with SMT.
• Identification of practice standards, informed consent, and reporting of adverse events.

Main Results:

• Strong evidence supports SMT as a conservative option for acute, subacute, and chronic LBP, especially in multimodal care.
• Insufficient or conflicting evidence exists for SMT in neck pain, headaches, and extremity disorders.
• Serious adverse events from SMT are rare but potentially underreported; minor soreness is common. Screening for contraindications is critical.

Conclusions:

• SMT is a viable conservative treatment for LBP within a multimodal approach.
• Current evidence does not support SMT for non-musculoskeletal conditions or broadly for other spinal/extremity issues.
• Variability in practice, consent, and adverse event reporting necessitates further research to clarify SMT's true effectiveness and safety.