Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment

J Manipulative Physiol Ther. Mar-Apr 2004;27(3):197-210. doi: 10.1016/j.jmpt.2003.12.023.

Abstract

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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cauda Equina
  • Female
  • Humans
  • Intervertebral Disc Displacement / rehabilitation
  • Intervertebral Disc Displacement / therapy*
  • Low Back Pain / rehabilitation
  • Lumbar Vertebrae*
  • Male
  • Manipulation, Chiropractic / adverse effects
  • Manipulation, Chiropractic / methods
  • Manipulation, Chiropractic / standards*
  • Manipulation, Orthopedic / adverse effects
  • Manipulation, Orthopedic / methods
  • Manipulation, Orthopedic / standards*
  • Nerve Compression Syndromes / etiology
  • Quality Assurance, Health Care
  • Time Factors
  • Treatment Outcome