title: Safety of spinal manipulation in the treatment of lumbar disk herniations: 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.
  
  
  METHODS
  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
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Comfort Health, 4607 Macleod Trail SW, Calgary, Alberta, Canada T2G 0A6.
authors.forename: Drew
authors.initials: D
authors.lastname: Oliphant
mesh_terms: D002420:Cauda Equina; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000534:rehabilitation / Q000628:therapy*; D017116:Low Back Pain / Q000534:rehabilitation; D008159:Lumbar Vertebrae; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D008349:Manipulation, Orthopedic / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D009408:Nerve Compression Syndromes / Q000209:etiology; D011785:Quality Assurance, Health Care; D013997:Time Factors; D016896:Treatment Outcome