A Review of the Reported Complications
from Spinal Manipulation

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

Managing Geriatric Spine Patients
By John J. Triano, D.C.,Ph.D.
Co-Director, Conservative Medicine
Texas Back Institute &
Adjunct Faculty, UT Southwestern Medical Center & UT Arlington
Department of Biomechanical Engineering
Joint Committee on Graduate Studies

In “Chiropractic Management of Geriatric Disorders”, Edited by Bougie. In press 2000

---

Treatment effectiveness and safety are the first objectives. In the management of the geriatric patient, these goals are even more important with reduced strength, endurance and tissue capacity associated with aging and disease. The mainstay of chiropractic treatment is mechanical in nature.  The doctor uses controlled forces and moments to alter joint function and stress distribution.  Loads may be applied directly by manipulative procedures or indirectly through exercise. Both local and remote effects may be observed, depending on the nature of the tissues injured by the FSL.

In general, chiropractic treatment has little associated risk. Table TX5 displays the complications of spinal manipulation that have been reported [Haldeman, Haldeman, LeBoeuf-Yve]. Nearly all reactions to manipulation are mild and self-limiting, lasting less than 24 hours. Rarely, significant injury can result from injudicious or inappropriate use. The incidence of serious complication is less than 1:1,000,000.

Table TX5: Complications from spinal manipulation expressed in terms of the percent of reported adverse reactions, where possible, and estimated percent of procedures performed.

Post-manipulation Adverse Reaction	Percent Reported Cases	Percent of Procedures
Aggravation of presenting complaint [Haldeman 1993] [Senstad 1997]	Unavailable	Unavailable
New pain at local site [Haldeman 1993] [Senstad 1997]	50%	12.5%
New pain at remote site [Haldeman 1993] [Senstad 1997]	10%	2.5%
Headache [Senstad 1997]	12%	3.0%
Fatigue [Senstad 1997]	11%	2.75%
Dizziness [Senstad 1997]	5%	1.25%
Nausea [Senstad 1997]	4%	1%
Warm surface sensations [Senstad 1997]	2%	0.5%
Other [Senstad 1997]	2%	0.5%
Cerebrovascular incident [Haldeman 1992]	Unavailable	0.000001%
Cauda Equina Syndrome [Haldeman 1992]	Unavailable	10 cases since 1911

Haldeman, S., Rubenstein S.M.:
Cauda equina syndrome in patients undergoing manipulation of the lumbar spine.
Spine V17 1992, 1469-1473.

Haldeman, S., Rubenstein S.M.:
The precipitation or aggravation of musculoskeletal pain in patints receiving spinal manipulative therapy.
JMPT V16, 1993., 47-50.

Haldeman S, Kohlbeck FJ, McGregor M.
Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection
After Cervical Trauma and Spinal Manipulation
Spine (Phila Pa 1976) 1999 (Apr 15); 24 (8): 785–794

Senstad,O.; Leboeuf-Yde,C.; Borchgrevink,C.:
Frequency and characteristics of side effects of spinal manipulative therapy.
Spine V22, 435-441, 1997.


From: Chiropractic Management of Cervical Acceleration / Deceleration Injury / Whiplash Associated Disorders (WAD)
By John J. Triano, DC, PhD
In: Narayan Yoganandan, PhD, Frank A Pintar, PhD (eds).
“Frontiers in Whiplash Trauma: Clinical and Biomechanical”,
The Netherlands: IOS Press (2000, In Press)


Overall, manipulation of the neck is one of the safest treatment procedures in use [29] While rare, the adverse effects can be devastating, including paralysis and death from cerebrovascular accident. The morbidity rate is estimated over a range 0.2 to 1 serious complication per 1,000,000 procedures [28] This is in contrast to the rates of complications, including death, from other treatment methods for neck disorders. Non-steroidal anti-inflammatory medication (NSAIDs) is often prescribed for pain management. Peptic ulceration has been estimated to occur in up to 3 [2] Elder patients show a three to five fold increase of bleeding ulcers leading to hospitalization and death [23] In the case of surgical intervention, the mortality due to complications of anesthesia can reach 1 per 1,000. [35]

2. Bjarnason I, Hayllar J, MacPherson AJ, Russell AS.
Side effects of non-steroidal anti-inflammatory drugs on the small an d large intestine in humans.
Gastroenterology 1993; 104(6):1832-47.

23. Gabriel SE, Jaakkimainen L, Bombardier C.
Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drus: a meta-analysis.
Ann Internal Med 1991; 115(10):787-96.

28. Haldeman S.
Personal communication.
1993.

29. Haldeman S.
Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation.
Spine 1999; 24(8):785-94.

35. McGregor M, Haldeman S, Kohlbeck FJ.
Vertebrobasilar compromise associated with cervical manipulation.
Topics in Clinical Chiropractic 1995; 2(3):63-73.

Return to STROKE AND CHIROPRACTIC

Since 6-01-2000