A Systematic Review and Risk Assessment

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.

Results:
An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation 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.

References:
Journal of Manipulative and Physiological Therapeutics, Volume 27, Issue 3, Pages 197-210 (March 2004)