This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 SMT sessions results in a grade ≥ 3 (severe) AE. A secondary objective was to examine independent predictors of grade ≥ 3 AEs. We identified patients with SMT-related AEs from January 2017 through August 2022 across 30 chiropractic clinics in Hong Kong. AE data were extracted from a complaint log, including solicited patient surveys, complaints, and clinician reports, and corroborated by medical records. AEs were independently graded 1–5 based on severity (1-mild, 2-moderate, 3-severe, 4-life-threatening, 5-death). Among 960,140 SMT sessions for 54,846 patients, 39 AEs were identified, two were grade 3, both of which were rib fractures occurring in women age > 60 with osteoporosis, while none were grade ≥ 4, yielding an incidence of grade ≥ 3 AEs of 0.21 per 100,000 SMT sessions (95% CI 0.00, 0.56 per 100,000). There were no AEs related to stroke or cauda equina syndrome. The sample size was insufficient to identify predictors of grade ≥ 3 AEs using multiple logistic regression. In this study, severe SMT-related AEs were reassuringly very rare.

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Cervicogenic dizziness (CGD) is a syndrome of neck pain accompanied by a false sensation of unsteadiness and dizziness due to neck pathology. An 11-year-old girl presented with neck pain and dizziness for four months. According to the patient’s statement, her complaints were likely related to the prolonged smartphone use for texting. Sagittal radiograph showed cervical kyphosis, anterior wedging of several vertebrae, and mild anterolisthesis of C2 on C3 and C3 on C4. These findings might be present in as physiological variants in children. However, continuous static stress in the minor variants could aggravate biomechanical problems, such as cervicogenic dizziness. After ruling out other neurological or vestibular problems, a multicomponent approach consisted of thermal ultrasound therapy, cervical manipulation, and intermittent motorized cervicothoracic traction to release cervical complaints. Three months later, the patient reported a resolution of neck pain and dizziness. At 12-month follow-up, all radiographic metrics showed improvement, including restoration of cervical alignment and lordotic curvature. The immature growing cervical spine has unique anatomic, physiologic and biomechanical features. A static neck flexion can lead to typical injury patterns seen in this age group. This article aims to raise awareness of the potential harms of excessive smartphone use by children.

Text neck describes an overuse injury of the cervical spine resulting from the repetitive stress of prolonged forward head flexion while looking down on a mobile screen. This case report describes a 24-year-old young man who presented with a 12-month history of head and neck pain and paresthesia of the right upper limb. The patient worked as a YouTuber and has been editing and posting videos on the website for three years. One year prior to referral for chiropractic assessment, the patient first visited his family physician for similar complaints. Based on cervical radiographs, the diagnosis of cervical spondylosis was given. Previous management included pain medication and muscle relaxants. Interventions included repeated physical therapy, cervical traction, and acupuncture, with some temporary relief during the subsequent year. However, severe flare-up of the symptoms occurred, which was brought about by working for extended periods on his smartphone, for which the patient sought chiropractic attention. X-ray imaging showed cervical kyphosis with C5 vertebral rotation, hypertonicity of the paraspinal muscles, and paresthesia in the right C6 dermatome distribution, which were consistent with text neck syndrome associated with cervical spondylosis and right C6 radiculopathy. The intervention consisted of improving posture while texting, cervical manipulation, and extension traction therapy. After 9 months of treatment sessions, the symptomatic and functional improvement was reflected by the radiographic changes in the cervical curve correction and the normalized paraspinal muscle tension on surface electromyology. Frequent breaks along with correct posture while using smartphones will be the key entities to prevent the occurrence of text neck syndrome.

Background The term “persistent spinal pain syndrome type 2” (PSPS-2) has been proposed by the International Association for the Study of Pain to replace the term “failed back surgery syndrome”. This retrospective study aimed to evaluate effectiveness of multimodal care featuring chiropractic spinal manipulation (CSMT) in 31 adults in Hong Kong with PSPS-2. Material/Methods We identified new adult patients with PSPS-2 receiving CSMT from 2016 to 2018. Demographic and clinical data and baseline/follow-up numeric pain rating scale (NPRS) and Oswestry Disability Index (ODI) scores were extracted. Multiple linear regression was used to examine posttreatment NPRS and ODI reduction, with clinical variables as covariates. Results Of 6589 patients with low back pain, 31 met criteria (mean age 52.2±13.7 years). Surgeries included laminectomy (81%), discectomy (13%), and fusion (6%). Mean baseline NRPS was 6.6±1.9; ODI was 43.8±15.1%. Patients received CSMT (100%), drop technique (81%), passive modalities (65%), soft tissue manipulation (13%), flexion-distraction (13%), and mechanical traction (13%). Mean posttreatment NPRS was 0.6±1.0; ODI was 2.4±3.3%. All patients had a minimum clinically important difference for NPRS (≥2/10) and ODI (≥30%). One year after treatment, 48% maintained improvement, 42% experienced recurrence; in 10%, follow-up was unavailable. Regression analysis identified younger age, shorter symptom duration, and greater baseline NPRS as predictors of NPRS reduction; and greater baseline ODI as a predictor of ODI reduction (all P <0.05). Conclusions Patients with PSPS-2 improved with multimodal care featuring CSMT, which was more effective in patients with younger age, shorter symptom duration, and higher baseline pain or disability levels.