The risk associated with spinal manipulation: an overview of reviews

Abstract

BackgroundSpinal manipulative therapy (SMT) is a widely used manual treatment, but many reviews exist with conflicting conclusions about the safety of SMT. We performed an overview of reviews to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT.MethodsWe searched five electronic databases from inception to December 8, 2015. We included reviews on any type of studies, patients, and SMT technique. Our primary outcome was SAEs. Quality of the included reviews was assessed using a measurement tool to assess systematic reviews (AMSTAR). Since there were insufficient data for calculating incidence rates of SAEs, we used an alternative approach; the conclusions regarding safety of SMT were extracted for each review, and the communicated opinion were judged by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios (RRs) of a review communicating that SMT is safe and meeting the requirements for each AMSTAR item, were calculated.ResultsWe identified 283 eligible reviews, but only 118 provided data for synthesis. The most frequently described adverse events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 manipulations. Low methodological quality was present, with a median of 4 of 11 AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements for each of the AMSTAR items (i.e. good internal validity) had a higher chance of expressing that SMT is safe.ConclusionsIt is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of SAEs reported can indeed be significant, sustaining that some risk is present. High quality research and consistent reporting of AEs and SAEs are needed.Systematic review registrationPROSPERO CRD42015030068.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0458-y) contains supplementary material, which is available to authorized users.

Characterizing Adverse Events Reported Immediately After Osteopathic Manipulative Treatment

“…The OMT techniques currently used in practice were more diverse than the chiropractic high-velocity thrust techniques evaluated in previous studies. 10,19 Additionally, results from The current study had several limitations. Current evidence indicates that the overall incidence of serious adverse events in manual therapies is quite low.…”

“…Current evidence indicates that the overall incidence of serious adverse events in manual therapies is quite low. 10,19 Based on an estimated rate of 1.3 serious adverse events per 1000 manual therapy sessions, 10 Future research evaluating safety of OMT and other forms of manual therapy will require researchers to face several challenges. First, the duration of effect from manual therapy during which adverse events are monitored needs to be defined to accurately assess adverse events and reactions.…”

Impulstechniken an der HWS

“…Eine Übersichtsstudie von 2016 [13] kommt zu dem Ergebnis, dass bisherige Studien zur Ermittlung von Zusammenhängen viele Schwachstellen haben und keine klare Verbindung zwischen Impulstechniken und Dissektionen besteht. Auch in einer Übersichtsstudie von 2017 [14] kommen Autoren zu dem Schluss, dass keine klare Evidenz für einen ursächlichen Zusammenhang zwischen einer Impulstechnik an der HWS und einer Dissektion besteht. Aufgrund der möglichen schwerwiegenden Auswirkungen einer Dissektion (meist durch einen resultierenden Schlaganfall) betonen die Autoren, dass man Impulstechniken bei dieser unklaren Studienlage bisher trotzdem nicht als risikofrei einstufen sollte.…”

Disección de arteria vertebral en pacientes que recibieron terapia de manipulación espinal. Serie de casos.

“…Las arterias de la circulación anterior son esencialmente móviles en su trayectoria cervical, protegida por músculos y tejido adiposo, pero expuesta a mayor compromiso por daño endotelial, estado protrombótico y activación de proteasas en casos infecciosos, principalmente en contexto de infección de vías aéreas. Mientras que la arteria vertebral (AV) está anclada a la columna cervical, lo que podría convertirla en más vulnerable a las manipulaciones mecánicas 1,4 . La terapia de manipulación espinal (TME), ampliamente empleada para el tratamiento de dolor cervical, consiste en terapia manual donde la articulación vertebral se moviliza pasivamente entre el rango de límites anatómicos.…”