Serious Adverse Events and Spinal Manipulative Therapy of the Low Back Region: A Systematic Review of Cases

Abstract

Objective: To systematically search the literature for studies reporting serious adverse events following lumbopelvic spinal manipulative therapy (SMT) and to describe the case details. Methods:A systematic search was conducted in PubMed including MEDLINE, EMBASE, CINAHL and The Cochrane Library up to January 12, 2012 by an experienced reference librarian. Study selection was performed by 2 independent reviewers using predefined criteria.We included cases involving individuals 18 years or older who experienced a serious adverse event following SMT applied to the lumbar spine or pelvis. A serious adverse event was defined as an untoward occurrence that results in death or is life threatening, requires hospital admission, or results in significant or permanent disability. We included studies published in English, German, Dutch and Swedish.Results: 2046 studies were screened and 41 studies reporting on 77 cases were included. Important case details were frequently unreported. Adverse events consisted of cauda equina syndrome (29 cases, 38% of total), lumbar disc herniation (23 cases, 30%), fracture (7 cases, 9%), hematoma or hemorrhagic cyst (6 cases, 8%), or other serious adverse events (12 cases, 16%) such as neurological or vascular compromise, soft tissue trauma, muscle abscess formation, disrupted fracture healing and esophageal rupture. Conclusions:This systematic review describes the case details of serious adverse events reported to occur following SMT of the lumbopelvic region. The anecdotal nature of these reports does not allow for causal inferences between SMT and the events identified in this review. Recommendations regarding future case reporting and research aimed at furthering the understanding of SMT's safety profile are discussed.

Risk of Traumatic Injury Associated With Chiropractic Spinal Manipulation in Medicare Part B Beneficiaries Aged 66 to 99 Years

“…A 2013 systematic review of serious adverse events following SM found cases of cauda equina syndrome (38%); lumbar disk herniation (30%); fracture (9%); and formation of hematoma or hemorrhagic cyst (8%). 25 A 2012 literature review of accidents associated with cervical SM over a 32 year period in China found cases of cord injury or compression, nerve root injury, cervical spine dislocation, and soft tissue injury. 26 This report may have overestimated the risks of SM performed by a licensed chiropractor however, because the practice of chiropractic in China is unrecognized and unregulated.…”

Tissue loading created during spinal manipulation in comparison to loading created by passive spinal movements

“…Specifically, SMT creates significant changes in spinal stiffness, muscle response and disc diffusion in SMT responders while these same changes are not observed in SMT non-responders234. In addition, approximately 30–50% of persons who receive SMT experience some kind of benign adverse event that typically self-resolves in 24–48 hours567, with a minority of patients experiencing serious adverse events8910. However, causation in these cases remains controversial79101112.…”

The risk associated with spinal manipulation: an overview of reviews

“…Some of these reviews further specified SMT as cervical, thoracic or lumbar SMT (21 reviews [46, 47, 49, 54, 57, 65, 91, 96, 103, 105, 114, 115, 119, 121, 123, 125–127, 134, 136, 150]). Other reviews did not further specify than ‘manipulation’ (10 reviews [36, 66, 70–73, 79, 93, 101, 107]), ‘osteopathic manipulative treatment/therapy’ (8 reviews [38, 52, 56, 64, 81, 82, 116, 139]), and ‘chiropractic care/interventions’ (5 reviews [67, 98–100, 137]).…”