Spinal Manipulation Should Not Be Routinely Used, New Study Warns

July 2, 2007

According to a study published in the Journal of the Royal Society

of Medicine, spinal manipulation should not be used routinely.

Routine use of spinal manipulation on the upper spine could result

in serious complications, such as stroke, and even death.

Lead researcher Edzard Ernst, Professor of Complementary Medicine at

Peninsular Medical School, Universities of Exeter and Plymouth,

said " Even allowing for an extraordinarily high level of under-

reporting, spinal manipulation has been associated with about 600

serious adverse events. In addition, it causes non-serious adverse

effects in about 50 percent of all patients who use it. If any drug

were linked to such rates of harm, I somehow doubt that it would

still be on the market. "

Case reports, retrospective case series, prospective case series,

case-controlled studies and surveys were reviewed by the Prof.

Ernst. Clear evidence was found of adverse events, from low level

pain to disc herniation, bone fractures, spinal cord injury and

stroke.

Several studies identified a link between routine spinal

manipulation when the cervical vertebrae are involved and risk of

adverse effects. Prof. Ernst believes patients may not be receiving

enough information regarding the risks associated with spinal

manipulation that would allow them to give informed consent. It is

not uncommon for serious adverse effects not to be reported in the

medical literature.

Professor Ernst said " The very high level of under-reporting in this

area suggests that the adverse effects that have been identified are

just the tiny tip of a very large iceberg " .

Dr. Kamram Abbasi, editor of the Journal of the Royal Society of

Medicine said " Evaluation of non-drug interventions is a thorny

issue, particularly those used in complementary therapies. The

central issue here is ensuring that sufficient high-quality evidence

is available for patients so that they can make an informed decision

before beginning any therapy. We spend a great deal of time minutely

scrutinising certain interventions, while many others offered by the

health service are relatively unstudied. "

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