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Chiropractic Research Review

On the Safety of Cervical Adjustments

Complications resulting from any procedure are always unfortunate, regardless of the profession administering health care. While a certain degree of inherent risk accompanies all health interventions and many diagnostic procedures, concerns have been raised over the safety of spinal manipulative therapy (SMT), particularly with regard to the potential danger of cerebrovascular accidents (CVAs).

This paper discusses the safety of SMT by detailing the relative rarity of adverse events associated with manipulation, and by comparing the mortality and morbidity rates of nonsteroidal anti-inflammatories (NSAIDs) and other medical procedures with SMT.

In this literature review, the author notes the rate of CVAs in the general population and compares it with the rate of CVAs in chiropractic patients. For example, in one reviewed study, the rate of fatal vertebral artery damage following cervical SMT was calculated to be 0.00025% (1 in 400,000 manipulations) in the United States. This was compared to the rate of deaths from CVA in the general U.S. population, calculated as 0.00057% (1 in 176,900 CVAs).

Results: On analysis, spinal manipulation is one of the most conservative, least invasive and safest procedures provided within the health care professions. As the author asserts, "a potential risk of catastrophic side-effects from SMT is substantially less than for any of the medical procedures or interventions listed in the tables accompanying this paper." However, he also notes that professions utilizing SMT must continually strive to minimize possible adverse events.

Take Note: While this literature review lacks clearly defined and reproducible methods, it points out the importance of discussing the risks of SMT in the context of other forms of care and the natural incidence of disorders.

Rome PL. Perspectives: an overview of comparative considerations of cerebrovascular accidents. Chiropractic Journal of Australia, Sept. 1999:29(3), pp87-102.
Reprints: Tel: +61-2-6921-3238; Fax: +61-2-6926-2556

Chiropractic Research Review

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