Safety of thrust joint manipulation in the thoracic spine: a systematic review

Abstract

Background: There appears to be very little in the research literature on the safety of thrust joint manipulation (TJM) when applied to the thoracic spine. Purpose: To retrospectively analyze all available documented case reports in the literature describing patients who had experienced severe adverse events (AE) after receiving TJM to their thoracic spine. Data Sources: Case reports published in peer reviewed journals were searched in Medline (using Ovid Technologies, Inc.), Science Direct, Web of Science, PEDro (Physiotherapy Evidence Database), Index of Chiropractic literature, AMED (Allied and Alternative Medicine Database), PubMed and the Cumulative Index to Nursing and Allied Health (CINHAL) from January 1950 to February 2015. Study Selection: Case reports were included if they: (1) were peer-reviewed; (2) were published between 1950 and 2015; (3) provided case reports or case series; and (4) had TJM as an intervention. Articles were excluded if: (1) the AE occurred without TJM (e.g. spontaneous); (2) the article was a systematic or literature review; or (3) it was written in a language other than English or Spanish. Data Extraction: Data extracted from each case report included: gender; age; who performed the TJM and why; presence of contraindications; the number of manipulation interventions performed; initial symptoms experienced after the TJM; as well as type of severe AE that resulted. Results: Ten cases, reported in 7 case reports, were reviewed. Cases involved females (8) more than males (2), with mean age being 43.5 years (SD=18.73, Range = 17 -71). The most frequent AE reported was injury (mechanical or vascular) to the spinal cord (7/10), with pneumothorax and hematothorax (2/10) and CSF leak secondary to dural sleeve injury (1/10). Limitations: There were only a small number of case reports published in the literature and there may have been discrepancies between what was reported and what actually occurred, since physicians dealing with the effects of the AE, rather than the clinician performing the TJM, published the cases. Conclusions: Serious AE do occur in the thoracic spine, most commonly, trauma to the spinal cord, followed by pneumothorax. This suggests that excessive peak forces may have been applied to thoracic spine, and it should serve as a cautionary note for clinicians to decrease these peak forces.

Thrust joint manipulation utilization by U.S. physical therapists

“…10,24 It is also possible that therapists may not be as aware of adverse events associated with TJM to the thoracic spine, and a recent systematic review has highlighted the need for therapists to monitor the forces they use in this area of the spine and reconsider the risks. 25 When asked to consider any barriers to the use of TJM by physical therapists, a majority of respondents felt that inadequate training (entry-level and postgraduate), insufficient mentoring and safety were of greatest concerns. While all professional physical therapy programs however, this may be explained by the fact that they limited their survey to manipulative physical therapists in the U.K. whereas our study was open to any practicing physical therapist regardless of practice setting.…”

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]).…”

Safety of thrust joint manipulation in the thoracic spine: a systematic review

“…We read with interest the article titled 'Safety of thrust joint manipulation (TJM) in the thoracic spine: a systematic review' in a recent issue of Journal of Manual and Manipulative Therapy. 1 The authors should be commended for the quality of the review and for increasing awareness about TJM in general. However, it is not appropriate to use case reports as a measure of safety.…”