Adverse effects of spinal manipulation: a systematic review

Ernst, Edzard

doi:10.1177/014107680710000716

Cited by 182 publications

(137 citation statements)

References 67 publications

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“…8 These findings do not argue against the use of such treatments but serve as reminders of limitations and possible harmful effects. The mean duration of pain in patients who seek treatment at chronic pain treatment facilities is approximately 7 years.…”

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confidence: 98%

“…[3][4][5] In some studies, investigators reported that more than 40% of patients with implanted devices for pain control experience adverse events 6 ; up to 67.7% of patients treated with lumbar surgery for back pain reported that their pain was worse after surgery, 7 and at least moderate adverse effects have been reported to occur in 30% to 61% of all patients who undergo spinal manipulations. 8 These findings do not argue against the use of such treatments but serve as reminders of limitations and possible harmful effects. The mean duration of pain in patients who seek treatment at chronic pain treatment facilities is approximately 7 years.…”

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confidence: 98%

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Assessment and Treatment of Psychosocial Comorbidities in Patients With Neuropathic Pain

Turk

Audette

Levy

et al. 2010

Mayo Clinic Proceedings

144

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[3][4][5] In some studies, investigators reported that more than 40% of patients with implanted devices for pain control experience adverse events 6 ; up to 67.7% of patients treated with lumbar surgery for back pain reported that their pain was worse after surgery, 7 and at least moderate adverse effects have been reported to occur in 30% to 61% of all patients who undergo spinal manipulations. 8 These findings do not argue against the use of such treatments but serve as reminders of limitations and possible harmful effects. The mean duration of pain in patients who seek treatment at chronic pain treatment facilities is approximately 7 years. 9 Consequently, all domains of their lives may have been compromised for a substantial amount of time. It is hardly surprising that levels of emotional distress for patients with persistent pain are high. Estimates suggest that at least 1 current psychiatric diagnosis is present in 59% of patients with chronic back pain treated at pain facilities and at least 1 lifetime psychiatric diagnosis is present in 77% of these patients. 10 In contrast, community estimates are 15% for at least 1 current psychiatric diagnosis and 29% to 38% Chronic neuropathic pain is a prevalent problem that eludes cure and adequate treatment. The persistence of intense and aversive symptoms, inadequacy of available treatments, and impact of such pain on all aspects of functioning underscore the important role of several psychosocial factors in causing, maintaining, and amplifying the perception of pain severity, coping adequacy, adaptation, impaired physical function, and emotional distress responses. Moreover, these factors have an influential role in response to treatment recommendations. In this article, we (1) review the prevalence and nature of emotional distress, (2) describe and propose methods for screening and comprehensive psychosocial assessment, and (3) review evidence supporting the potential complementary role of psychosocial treatments of patients with chronic pain. The cognitive-behavioral perspective and treatment approach are emphasized because the greatest amount of evidence supports their benefits. Published results of psychological treatments are modest; however, the same indictment can be placed on currently available pharmacological, medical, and interventional treatments for patients with chronic pain. We note the limited research on the effectiveness of psychological treatment specifically applied to patients with chronic neuropathic pain but suggest that it is reasonable to extrapolate from successful trials in other types of chronic pain. Furthermore, psychological approaches should not be viewed as alternatives but rather should be integrated as part of a comprehensive approach to the treatment of patients with chronic neuropathic pain. Mayo Clin © 2010 Mayo Foundation for Medical Education and ResearchC hronic neuropathic pain is a prevalent problem that eludes successful treatment. Despite increasing knowledge of the neurophysiologic factors underlying neuropathic pa...

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confidence: 98%

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confidence: 98%

Assessment and Treatment of Psychosocial Comorbidities in Patients With Neuropathic Pain

Turk

Audette

Levy

et al. 2010

Mayo Clinic Proceedings

144

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“…The most frequent complications were vertebral artery injury (65.1%) and intervertebral disc complications (22.5%) [13]. An extensive literature review by Ernst [4] focusing on chiropraxis complications revealed that the most frequent lesion reported was dissection of the vertebral arteries, and others included dural tear, edema, nerve injury, disc herniation, hematoma and bone fracture.…”

Section: Discussionmentioning

confidence: 99%

Acute paraplegia after chiropraxis

López-González

Peris-Celda

2010

Eur Spine J

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Spinal manipulation is a form of back and other musculoskeletal pain treatment that often involves a highvelocity thrust, a technique in which the joints are adjusted rapidly. The main objective of chiropractors is to correct spinal malalignment and relieve the nerves, allowing them to function optimally (Ernst In: Expert Rev Neurother 7:1451-1452 Oppenheim et al. In: Spine J 5:660-666, 2005 16-25, 2007; Thiel et al. In: Spine 32: 2375-2378. Several case reports and series have been focusing on the risks of chiropraxis, especially on the cervical spine, although the risk/benefit ratio for certain selected patients could be acceptable (Powell et al.In: Neurosurgery 33:73-78, 1993). We describe the case of a 45-year-old woman who suffered complete paraplegia shortly after a chiropractic maneuver in the thoracic spine. Dorsal CT showed a calcified disc herniation at the T8-T9 level and MRI revealed a diffuse spinal cord ischemia from T6 to the conus medullaris without spinal cord compression at the level of herniation. Despite a normal arteriography, authors suggest a vascular injury as the cause of the deficit.Keywords Chiropraxis Á Spinal cord ischemia Á Acute paraplegia Á Herniated disc Clinical caseA 45-year-old woman was admitted to the Neurosurgery Department of our hospital with the diagnosis of traumatic thoracic disc herniation and complete paraplegia of 12 h of evolution. She was first attended to in another hospital and then urgently sent to our department.When the patient arrived at the emergency room, she had grade 0/5 motor strength in both the lower extremities, abolished deep tendon reflexes and complete sensory loss below the T8-T9 level. She had previously refused NASCIS protocol, which was offered at the first hospital, but she finally accepted it after being admitted to our department.She had a history of only diffuse, not irradiated middle and low back pain and was being treated with chiropractic sessions for 2 years. On the day of onset of her paraplegia, she went to one of those sessions and suffered an unusual but temporary thoracic pain when the chiropractor was manipulating her middle thoracic zone. Approximately 20 min after the end of the session, she felt proximal weakness in her lower extremities, and the symptoms of a complete paraplegia and spine cord shock were progressively established within a 1-2-h period.The blood and urinary analyses, including C-reactive protein levels and the globular sedimentation rate, were normal and the body temperature was 36.5°C.A magnetic resonance imaging (MRI) performed at the hospital of origin 5 h after the beginning of the weakness showed two anomalies: one disc herniation (T8-T9) (Fig. 1a) and hypersignal under the T9 level in a T2A. Lopez-Gonzalez and M. Peris-Celda contributed equally.

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“…The risk-benefit ratio with regard to manipulation of the cervical spine should be evaluated, as this procedure has been associated with mild to moderate adverse effects and serious adverse effects related to the vertebral artery 13) . To avoid such problems, mobilization and manipulation of another region of the spinal column, such as the thoracic spine, have been employed instead of cervical manipulation 7) .…”

Section: Introductionmentioning

confidence: 99%

Analysis of Thoracic Spine Thrust Manipulation for Reducing Neck Pain

et al. 2013

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Abstract.[Purpose] The cervical spine is a common site of pain, which may arise from different parts of the upper limbs or dysfunctions of the upper thoracic spine. The different sections of the spinal column are interlinked, and one region exerts an influence over another. Thus, a low range of motion (hypomobility) in the thoracic spine is an indicator of neck pain, and alterations in the cervical spine can occur due to dysfunctions of the thoracic region. The aim of the present study was to assess the efficacy of upper thoracic spine (T1-T4) thrust manipulation with regard to reduction of pain and disability in patients with neck pain. [Subjects and Methods] Twenty-five individuals with persistent neck pain upon movement participated in this study. The individuals were evaluated using the Neck Disability Index and a visual analog scale for pain. Each individual underwent five sessions of thoracic spine thrust manipulation. Data analysis involved the Student's t-test.[Results] Significant improvements were found in neck pain and disability.[Conclusion] Based on the results of the present study, thoracic spine thrust manipulation proved effective in the treatment of individuals with neck pain, leading to a reduction in both pain and disability.

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Adverse effects of spinal manipulation: a systematic review

Cited by 182 publications

References 67 publications

Assessment and Treatment of Psychosocial Comorbidities in Patients With Neuropathic Pain

Assessment and Treatment of Psychosocial Comorbidities in Patients With Neuropathic Pain

Acute paraplegia after chiropraxis

Analysis of Thoracic Spine Thrust Manipulation for Reducing Neck Pain

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