title: Adverse effects of spinal manipulation: a systematic review.
abstract: OBJECTIVE
  To identify adverse effects of spinal manipulation.
  
  
  METHODS
  Systematic review of papers published since 2001.
  
  
  METHODS
  Six electronic databases.
  
  
  METHODS
  Reports of adverse effects published between January 2001 and June 2006. There were no restrictions according to language of publication or research design of the reports.
  
  
  RESULTS
  The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients. The case-control studies suggested a causal relationship between spinal manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature.
  
  
  CONCLUSIONS
  Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.
authors.affiliation: Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK. Edzard.Ernst@pms.ac.uk
authors.forename: E
authors.initials: E
authors.lastname: Ernst
mesh_terms: D004812:Epidemiologic Methods; D006801:Humans; D020393:Manipulation, Spinal / Q000009:adverse effects*; D008499:Medical Records; D020217:Vertebral Artery Dissection / Q000209:etiology