What are the risks of manual treatment of the spine? A scoping review for clinicians

Abstract

BackgroundCommunicating to patients the risks of manual treatment to the spine is an important, but challenging element of informed consent. This scoping review aimed to characterise and summarise the available literature on risks and to describe implications for clinical practice and research.MethodA methodological framework for scoping reviews was followed. Systematic searches were conducted during June 2017. The quantity, nature and sources of literature were described. Findings of included studies were narratively summarised, highlighting key clinical points.ResultsTwo hundred and fifty articles were included. Cases of serious adverse events were reported. Observational studies, randomised studies and systematic reviews were also identified, reporting both benign and serious adverse events.Benign adverse events were reported to occur commonly in adults and children. Predictive factors for risk are unclear, but for neck pain patients might include higher levels of neck disability or cervical manipulation. In neck pain patients benign adverse events may result in poorer short term, but not long term outcomes.Serious adverse event incidence estimates ranged from 1 per 2 million manipulations to 13 per 10,000 patients. Cases are reported in adults and children, including spinal or neurological problems as well as cervical arterial strokes. Case-control studies indicate some association, in the under 45 years age group, between manual interventions and cervical arterial stroke, however it is unclear whether this is causal. Elderly patients have no greater risk of traumatic injury compared with visiting a medical practitioner for neuro-musculoskeletal problems, however some underlying conditions may increase risk.ConclusionExisting literature indicates that benign adverse events following manual treatments to the spine are common, while serious adverse events are rare. The incidence and causal relationships with serious adverse events are challenging to establish, with gaps in the literature and inherent methodological limitations of studies. Clinicians should ensure that patients are informed of risks during the consent process. Since serious adverse events could result from pre-existing pathologies, assessment for signs or symptoms of these is important. Clinicians may also contribute to furthering understanding by utilising patient safety incident reporting and learning systems where adverse events have occurred.Electronic supplementary materialThe online version of this article (10.1186/s12998-017-0168-5) contains supplementary material, which is available to authorized users.

Outcomes indicators and a risk classification system for spinal manipulation under anesthesia: a narrative review and proposal

“…However, a recent systematic review found inadequate reporting of adverse events with spinal manipulative therapy (SMT), whether catastrophic or otherwise [ 64 ]. Swait and Finch report that serious adverse events with manual treatment of the spine appear to be rare, making it difficult to estimate risk level [ 65 ]. They note that pre-existing pathology may increase the risk of some events and call for enhanced knowledge through clinician use of patient safety incident reporting systems [ 65 ].…”

“…Swait and Finch report that serious adverse events with manual treatment of the spine appear to be rare, making it difficult to estimate risk level [ 65 ]. They note that pre-existing pathology may increase the risk of some events and call for enhanced knowledge through clinician use of patient safety incident reporting systems [ 65 ]. Cassidy et al reported no evidence of increased risk of vertebrobasilar artery (VBA) stroke [ 66 ] or carotid artery stroke [ 67 ] associated with chiropractic treatment versus primary care, suggesting coincidental occurrence.…”

Beliefs, perceptions and practices of chiropractors and patients about mitigation strategies for benign adverse events after spinal manipulation therapy

“…Similar to most health care interventions, adverse events (AEs) have been observed after SMT. Reported post-SMT AEs vary in terms of frequency and severity, ranging from the more frequent minor/benign AEs (such as increased soreness and stiffness) to rare and serious AEs (such as cauda equina syndrome) [5].…”

“…Previous studies estimated that about 50% of patients receiving SMT experience some kind of AE, most being benign, transient and self-resolving with little to no impact on activities of daily living [5][6][7].…”

Surface electromyography in manual therapy - categorization of purpose and quality of reporting

“…However, although several systematic reviews have been conducted to understand the effect of MT in temporomandibular disorders (TMD) and its positive effects have been highlighted, the quality of these studies is now considered low and more and better trials are needed (Armijo-Olivo et al, 2016). A scoping review aiming to understand the risks of manual treatment to the spine, found that benign adverse events following manual treatments were common while serious adverse effects are rare (Swait & Finch., 2017). Although there is some evidence of MT effectiveness, the evidence-informed primary care management of LBP states that there is some evidence to recommend MT as massage therapy and spinal manipulation for prevention and care of LBP (TOP., 2017).…”