How Safe Is Chiropractic Manipulation of the Neck?
This study was the first large-scale survey of chiropractors to estimate the incidence of serious effects from cervical spine (neck) manipulation. It is believed that the risk of serious problems from chiropractic manipulation is very low. But there are no studies to support this conclusion.
Chiropractors in England and Scotland were invited to complete a survey with details on treatment and outcomes for their patients. Patients included were 16 years of age or older. Treatment included at least one manipulation to the cervical spine.
One-third of all chiropractors registered in the British and Scottish Chiropractic Association participated in the study. Minor and more serious adverse effects of treatment were reported. Data from a total of 19,722 patients was analyzed.
Minor side effects of chiropractic manipulation were common. This included neck pain, stiffness and soreness, and headache. There were no serious adverse effects reported in this study. Such events might include stroke, hemorrhage, or neurologic problems.
The authors suggest the risk of a serious adverse event after cervical spine manipulation is low to very low. They conclude that this treatment approach is a relatively safe procedure. The risk is low when patients are treated by registered chiropractors.
An outside reviewer of the study pointed out several areas to consider. First, only one-third of the registered chiropractors participated in the study. This means the safety of treatment for patients under the care of the majority of chiropractors remains unknown.
Results for patients who were lost to follow-up or not followed-up at all were not included. Any adverse effects in these two groups were not reported. The researchers also had no way to know if chiropractors underreported negative reactions.
Likewise, patients may have failed to tell their chiropractors about problems after treatment. The outcomes for these factors could change how the data should be interpreted. The reviewer suggested that adverse events from cervical spine manipulation should be reported for every patient every time. This would mimic similar data already collected on every surgical patient.
Haymo W. Thiel, DC, PhD, et al. Safety of Chiropractic Manipulation of the Cervical Spine. A Prospective National Survey. In Spine. October 2007. Vol. 32. No. 21. Pp. 2375-2378.
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