SAFETY OF SPINAL MANIPULATION IN THE TREATMENT OF LUMBAR DISK HERNIATIONS: A SYSTEMATIC REVIEW AND RISK ASSESSMENT
 
   

Safety of Spinal Manipulation in the
Treatment of Lumbar Disk Herniations:
A Systematic Review and Risk Assessment

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:
   Frankp@chiro.org
 
   

FROM:   J Manipulative Physiol Ther 2004 (Mar);   27 (3):   197210 ~ FULL TEXT

Drew Oliphant, DC

Comfort Health,
4607 Macleod Trail SW,
Calgary, Alberta, Canada T2G 0A6


OBJECTIVE:   To provide a qualitative systematic review of the risk of spinal manipulation in the treatment of lumbar disk herniations (LDH) and to estimate the risk of spinal manipulation causing a severe adverse reaction in a patient presenting with LDH.

DATA SOURCES:   Relevant case reports, review articles, surveys, and investigations regarding treatment of lumbar disk herniations with spinal manipulation and adverse effects and associated risks were found with a search of the literature.

DATA SYNTHESIS:   Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH.

RESULTS:   An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million.

CONCLUSION:   The apparent safety of spinal manipulation, especially when compared with other "medically accepted" treatments for LDH, should stimulate its use in the conservative treatment plan of LDH.


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