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Manipulation of the cervical spine: risks and benefits
1Department of Physical Medicine and Rehabilitation, University of Minnesota, UMHC, Minneapolis 55455, USA. difab001@maroon.tc.umn.edu
Physical Therapy
|January 27, 1999
Summary
Manipulation of the cervical spine (MCS) carries risks, including arterial dissection and brain stem lesions, with an 18% mortality rate in reviewed cases. Physical therapists
Area of Science:
- Orthopedics
- Neurology
- Physical Therapy
Background:
- Manipulation of the cervical spine (MCS) is a treatment modality for neck pain and muscle-tension headache.
- Adverse events associated with MCS have been reported in medical literature.
- The specific risks and benefits of MCS require thorough evaluation.
Purpose of the Study:
- To review reported injuries attributed to MCS.
- To identify cases involving physical therapists in MCS-related injuries.
- To describe the risks and benefits associated with MCS.
Main Methods:
- A comprehensive review of 177 published cases of injury related to MCS.
- Analysis of cases reported in 116 articles published between 1925 and 1997.
- Identification of injury types and involvement of healthcare professionals.
Main Results:
- The most frequent injuries reported were arterial dissection/spasm and brain stem lesions.
- A significant mortality rate of 18% (32 cases) was observed in the reviewed injuries.
- Physical therapists were involved in less than 2% of cases, with no attributed deaths.
Conclusions:
- While the overall risk of MCS injury may appear low, it carries the potential for serious vertebral artery damage.
- Mobilization (non-thrust passive movements) may offer a safer alternative to avoid vertebral artery damage.
- Current literature does not conclusively demonstrate that the benefits of MCS outweigh its associated risks.