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

» Most evidence in low back pain (LBP): Evidence supports spinal manipulation therapy (SMT) as a conservative option for acute, subacute, and chronic LBP, especially when used as part of multimodal care.» Limited role beyond LBP: SMT shows insufficient or conflicting evidence for neck pain, headaches, extremity disorders, and is not recommended for nonmusculoskeletal conditions.» Risk profile: Serious adverse events are rare and may be underreported; minor, transient soreness is more common. Careful screening for contraindications (e.g., trauma, connective tissue disease, vascular disorders) is critical.» Ongoing gaps: Variability in practice standards, inconsistent informed consent, and poor adverse event reporting limit clarity on true effectiveness and safety.