Journal article
Serious adverse events and spinal manipulative therapy of the low back region: A systematic review of cases
Journal of Manipulative and Physiological Therapeutics, Vol.38(9), pp.677-691
2015
Abstract
Objective
The purpose of this study was to systematically search the literature for studies reporting serious adverse events following lumbopelvic spinal manipulative therapy (SMT) and to describe the case details.
Methods
A systematic search was conducted in PubMed including MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 12, 2012, by an experienced reference librarian. Study selection was performed by 2 independent reviewers using predefined criteria. We included cases involving individuals 18 years or older who experienced a serious adverse event following SMT applied to the lumbar spine or pelvis by any type of provider (eg, chiropractic, medical, physical therapy, osteopathic, layperson). A serious adverse event was defined as an untoward occurrence that results in death or is life threatening, requires hospital admission, or results in significant or permanent disability. We included studies published in English, German, Dutch, and Swedish.
Results
A total of 2046 studies were screened, and 41 studies reporting on 77 cases were included. Important case details were frequently unreported, such as descriptions of SMT technique, the pre-SMT presentation of the patient, the specific details of the adverse event, time from SMT to the adverse event, factors contributing to the adverse event, and clinical outcome. Adverse events consisted of cauda equina syndrome (29 cases, 38% of total); lumbar disk herniation (23 cases, 30%); fracture (7 cases, 9%); hematoma or hemorrhagic cyst (6 cases, 8%); or other serious adverse events (12 cases, 16%) such as neurologic or vascular compromise, soft tissue trauma, muscle abscess formation, disrupted fracture healing, and esophageal rupture.
Conclusions
This systematic review describes case details from published articles that describe serious adverse events that have been reported to occur following SMT of the lumbopelvic region. The anecdotal nature of these cases does not allow for causal inferences between SMT and the events identified in this review. Recommendations regarding future case reporting and research aimed at furthering the understanding of the safety profile of SMT are discussed.
Details
- Title
- Serious adverse events and spinal manipulative therapy of the low back region: A systematic review of cases
- Authors/Creators
- J.J. Hebert (Author/Creator) - Murdoch UniversityN.J. Stomski (Author/Creator) - Murdoch UniversityS.D. French (Author/Creator) - RMIT UniversityS.M. Rubinstein (Author/Creator) - Amsterdam Public Health
- Publication Details
- Journal of Manipulative and Physiological Therapeutics, Vol.38(9), pp.677-691
- Publisher
- Mosby Inc.
- Identifiers
- 991005540724107891
- Copyright
- National University of Health Sciences
- Murdoch Affiliation
- School of Health Professions; School of Psychology and Exercise Science
- Language
- English
- Resource Type
- Journal article
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.129 Back pain
- 1.129.98 Low Back Pain
- Web Of Science research areas
- Health Care Sciences & Services
- Integrative & Complementary Medicine
- Rehabilitation
- ESI research areas
- Clinical Medicine