PMID- 23633885
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20130502
LR  - 20220408
IS  - 1066-9817 (Print)
IS  - 2042-6186 (Electronic)
IS  - 1066-9817 (Linking)
VI  - 20
IP  - 2
DP  - 2012 May
TI  - Safety of cervical spine manipulation: are adverse events preventable and are 
      manipulations being performed appropriately? A review of 134 case reports.
PG  - 66-74
LID - 10.1179/2042618611Y.0000000022 [doi]
AB  - BACKGROUND: Cervical spine manipulation (CSM) is a commonly utilized 
      intervention, but its use remains controversial. PURPOSE: To retrospectively 
      analyze all available documented case reports in the literature describing 
      patients who had experienced severe adverse events (AEs) after receiving CSM to 
      determine if the CSM was used appropriately, and if these types of AEs could have 
      been prevented using sound clinical reasoning on the part of the clinician. DATA 
      SOURCES: PubMed and the Cumulative Index to Nursing and Allied Health were 
      systematically searched for case reports between 1950 and 2010 of AEs following 
      CSM. STUDY SELECTION: Case reports were included if they were peer-reviewed; 
      published between 1950 and 2010; case reports or case series; and had CSM as an 
      intervention. Articles were excluded if the AE occurred without CSM (e.g. 
      spontaneous); they were systematic or literature reviews. Data extracted from 
      each case report included: gender; age; who performed the CSM and why; presence 
      of contraindications; the number of manipulation interventions performed; initial 
      symptoms experienced after the CSM; and type of resultant AE. DATA SYNTHESIS: 
      Based on the information gathered, CSMs were categorized as appropriate or 
      inappropriate, and AEs were categorized as preventable, unpreventable, or 
      unknown. Chi-square analysis with an alpha level of 0.05 was used to determine if 
      there was a difference in proportion between six categories: 
      appropriate/preventable, appropriate/unpreventable, appropriate/unknown, 
      inappropriate/preventable, inappropriate/unpreventable, and 
      inappropriate/unknown. RESULTS: One hundred thirty four cases, reported in 93 
      case reports, were reviewed. There was no significant difference in proportions 
      between appropriateness and preventability, P = .46. Of the 134 cases, 60 (44.8%) 
      were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%) 
      were categorized as 'unknown'. CSM was performed appropriately in 80.6% of cases. 
      Death resulted in 5.2% (n = 7) of the cases, mostly caused by arterial 
      dissection. LIMITATIONS: There may have been discrepancies between what was 
      reported in the cases and what actually occurred, since physicians dealing with 
      the effects of the AE, rather than the clinician performing the CSM, published 
      many of the cases. CONCLUSIONS: This review showed that, if all contraindications 
      and red flags were ruled out, there was potential for a clinician to prevent 
      44.8% of AEs associated with CSM. Additionally, 10.4% of the events were 
      unpreventable, suggesting some inherent risk associated with CSM even after a 
      thorough exam and proper clinical reasoning.
FAU - Puentedura, Emilio J
AU  - Puentedura EJ
AD  - Department of Physical Therapy, School of Allied Health Sciences, University of 
      Nevada Las Vegas, Las Vegas, NV, USA.
FAU - March, Jessica
AU  - March J
FAU - Anders, Joe
AU  - Anders J
FAU - Perez, Amber
AU  - Perez A
FAU - Landers, Merrill R
AU  - Landers MR
FAU - Wallmann, Harvey W
AU  - Wallmann HW
FAU - Cleland, Joshua A
AU  - Cleland JA
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Man Manip Ther
JT  - The Journal of manual & manipulative therapy
JID - 9433812
PMC - PMC3360486
OTO - NOTNLM
OT  - Adverse events
OT  - Case reports
OT  - Cervical spine
OT  - Manipulation
OT  - Risk of harm
OT  - Safety
EDAT- 2013/05/02 06:00
MHDA- 2013/05/02 06:01
PMCR- 2013/05/01
CRDT- 2013/05/02 06:00
PHST- 2013/05/02 06:00 [entrez]
PHST- 2013/05/02 06:00 [pubmed]
PHST- 2013/05/02 06:01 [medline]
PHST- 2013/05/01 00:00 [pmc-release]
AID - 81 [pii]
AID - 10.1179/2042618611Y.0000000022 [doi]
PST - ppublish
SO  - J Man Manip Ther. 2012 May;20(2):66-74. doi: 10.1179/2042618611Y.0000000022.