EMBARGOED UNTIL 00:01HRS 1 JULY 2007
New study warns against routine use of spinal manipulation
Spinal manipulation should not be routinely used and, when performed on the upper spine, may result in serious, and possibly fatal, complications such as stroke, concludes a new study. The systematic review is published in the July issue of the Journal of the Royal Society of Medicine.
“Even allowing for an extraordinarily high level of under-reporting, spinal manipulation has been associated with about 600 serious adverse events,” said lead researcher Edzard Ernst, Professor of Complementary Medicine at Peninsula Medical School, Universities of Exeter and Plymouth.
He added: “In addition, it causes non-serious adverse effects in about 50 percent of all patients who use it. If any drug were linked to such rates of harm, I somehow doubt that it would still be on the market.”
The author reviewed case reports, retrospective case series, prospective case series, case-controlled studies and surveys and found evidence of adverse events which ranged from less serious problems - such as low level pain - to serious or even life-threatening events. These included disc herniation, bone fractures, spinal cord injury and stroke.
Several studies have identified dangers associated with spinal manipulation, particularly when the cervical vertebrae are involved. A systematic review of the literature was published in 2002 by Ernst and co-author, Claire Stevinson and looked at data available up to 2001. Further studies have been published since then and this review updates Professor Ernst’s previous work.
The author suggests that patients rarely receive enough information about the associated risks of spinal manipulation to allow them to give informed consent. Sometimes even serious adverse effects are not reported in the medical literature. “The very high level of under-reporting in this area suggests that the adverse effects that have been identified are just the tiny tip of a very large iceberg,” said Professor Ernst.
“Evaluation of non-drug interventions is a thorny issue, particularly those used in complementary therapies,” said Dr Kamran Abbasi, editor of the JRSM. “The central issue here is ensuring that sufficient high-quality evidence is available for patients so that they can make an informed decision before beginning any therapy. We spend a great deal of time minutely scrutinising certain interventions, while many others offered by the health service are relatively unstudied.”
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Adverse effects of spinal manipulation: a systematic review [99k]
Notes
Spinal manipulation or adjustment is a manual treatment where a vertebral joint is passively moved between the normal range of motion and the limits of its normal integrity, though a universally accepted definition does not seem to exist. It is occasionally used by osteopaths, physiotherapists and physicians, and it is the hallmark treatment of chiropractors.
Adverse effects of spinal manipulation: a systematic review by Professor Edzard Ernst, is published in the July issue of the Journal of the Royal Society of Medicine. Professor Ernst is available for comment.
JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi.
It is also available free at www.jrsm.org
