Adverse events following cervical spine self-manipulation: A systematic review

Case studies suggest self-manipulation of the cervical spine may result in adverse events (AEs). Self-management with self-manipulation is understudied. Thus, this systematic review (prospectively registered via International Prospective Register of Systematic Reviews #CRD42024540358) aimed to identify published cases of AEs following cervical self-manipulation, rate the severity of the events, report individual case characteristics, and characterize the method of cervical self-manipulation in each case.

Multiple databases were comprehensively searched for observational studies describing AEs following cervical spine self-manipulation from inception to May 2024. Screening, risk of bias (modified Joanna Briggs Institute checklist), and data extraction were each performed individually by two separate reviewers. Extracted data included case demographics, time between self-manipulation and AE, symptoms preceding self-manipulation, final AE diagnosis, AE treatments, and disposition after AE diagnosis and treatment. The primary outcome was AE severity, graded as mild, moderate, severe, or catastrophic.

Searches yielded 5714 unique articles; 24 were included describing 24 unique cases (71% male; mean age 34 years). Half the cases were precipitated by neck pain or stiffness (n = 12), involved cervical self-manipulation via the use of one's own hands (n = 15), and described a "sudden" or "immediate" onset of AE following cervical self-manipulation (n = 12). Adverse events were classified as mild (n = 4, 17%), moderate (n = 7, 29%), severe (n = 9, 38%), and catastrophic (n = 4, 17%). Of the four AEs categorized as catastrophic, two were fatalities. Almost all AEs occurred within 2 days following self-manipulation (n = 22).

Few cases of AEs following cervical self-manipulation have been reported. Although this practice has the potential for serious AEs, we did not identify evidence that such AEs are a common phenomenon. With very low certainty, this practice has the potential for serious harms. Further research is needed to describe the motivations for using cervical self-manipulation, its prevalence, incidence of associated AEs, and factors predisposing to AEs.