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Adverse events associated with spinal manipulation. Regarding neck manipulation, the risk/benefit ratio for the procedure appears to be in question due to the availability of safer options.
NOTE: In the UK, there appears to be no publicised national system for reporting adverse events related to chiropractic treatment. Furthermore, the UK General Chiropractic Council's current promotional literature appears to make no mention of serious risks.
"In conclusion, spinal manipulation is based on questionable pathological concepts and therefore lacks biological plausibility. Its risks may be considerable and its benefits have not been convincingly demonstrated in rigorous trials. What follows is sobering: the benefits of spinal manipulation do not seem worth the potential risks." Edzard Ernst, Expert Review of Neurotherapeutics, Vol. 7, No. 11, Pages 1451-1452 (November 2007) Full text available via this link.
The first case report of a lumbar epidural hematoma after chiropractic manipulation. Concludes that even rare complications after chiropractic manipulation of the spine should be weighed against potential benefits of such treatment. Neurosurgery (July 2007)
"There are multiple reports in the literature of serious and at times fatal complications after cervical spine manipulation therapy (CSMT), even though CSMT is considered by some health providers to be an effective and safe therapeutic procedure for head and neck pain syndromes." Leon-Sanchez A, Cuetter A, Ferrer G, Southern Medical Journal (February 2007)
Concludes that cervical spine manipulation should be considered a treatment with risk of neurological complications, including the occurrence of intracranial hypotension. The Journal of Headache and Pain (August 2006)
36 patients (mean age 40+11 years) with vertebral artery dissections associated with chiropractic neck manipulation were identified in neurological departments at university hospitals in Germany. 90% of patients admitted to hospital showed focal neurological deficits and among these 11% had a reduced level of consciousness. 50% of subjects were discharged after 20+/-14 hospital days with focal neurological deficits, one patient died and one was in a persistent vegetative state. Risk factors associated with artery dissections (e.g. fibromuscular dysplasia) were present in only 25% of subjects. Reuter U, Hamling M, Kavuk I, Einhaupl K M, Schielke E; for the German vertebral artery dissection study group. Journal of Neurology (March 2006) [pdf]
"Spinal manipulation can be associated with significant complications, often requiring surgical intervention." The Spine Journal (Nov-Dec 2005)
Conclusion: Upper spinal manipulation is associated with ophthalmological adverse effects of unknown frequency. Ophthalmologists should be aware of its risks. Rigorous investigations must be conducted to establish reliable incidence figures. Edzard Ernst, Acta Ophthalmologica Scandinavica (September 2005)
"…the best options for neck pain are fairly simple and inexpensive. Adding spinal manipulation to the regimen not only does not improve the situation, it may be detrimental." Edzard Ernst, The Guardian (9th August 2005)
Concludes: "Our results suggest that adverse reactions to chiropractic care for neck pain are common and that despite somewhat imprecise estimation, adverse reactions appear more likely to follow cervical spine manipulation than mobilization. GIven the possible higher risk of adverse reactions and lack of demonstrated effectiveness of manipulation over mobilization, chiropractors should consider a conservative approach for applying manipulation to their patients, especially those with severe neck pain". Spine (1st July 2005)
Irish television programme which contains a 22-minute segment (commencing after 12 minutes) about the dangers of chiropractic neck manipulation: "The attempts to minimise this by the chiropractic profession are astonishing and, to be frank, rather disgusting" — Brad Stewart, Canadian neurologist. The rebuttals made by Hagan McQuaid, International Vice-President of the Chiropractic Association of Ireland, are wholly unconvincing. The programme concludes by questioning the effectiveness of statutory regulation. Prime Time, RTE (5th May 2005)
"Spinal cord ischemia may deserve to be added to the list of possible adverse events after lumbar spine manipulation." Joint Bone Spine (July 2004)
"If neurological deficits occur after chiropractic manipulation, a spinal epidural hematoma should be considered to provide adequate therapy without delay. The current case report shows an unusual expansion of the hematoma which has not described so far after chiropractic manipulation." Z Orthop Ihre Grenzgeb. (Jan-Feb 2004)
"The preponderance of the scientific literature supports a direct cause-and-effect mechanism between spinal manipulation and stroke. The therapeutic benefit of spinal manipulation in acute neck pain remains unproven. The [American] public deserves to be provided a thorough informed consent by practitioners of spinal manipulation prior to any treatment being rendered. Further research into informed consent, stroke caused by spinal manipulation, and the therapeutic benefit of the procedure, if any, needs further investigation." Article by Preston Long, PhD, Journal of Quality Healthcare (2004) [pdf]
This study emphasises the potential dangers of chiropractic manipulation of the cervical spine. Journal of Neurology (October 2003)