Safety of chiropractic manipulation of the cervical spine: a prospective national survey.
METHODS
Prospective national survey.


OBJECTIVE
To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors.


BACKGROUND
The risk of a serious adverse event following chiropractic manipulation of the cervical spine is largely unknown. Estimates range from 1 in 200,000 to 1 in several million cervical spine manipulations.


METHODS
We studied treatment outcomes obtained from 19,722 patients. Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine. Serious adverse events, defined as "referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity," and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment.


RESULTS
Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events. This translates to an estimated risk of a serious adverse event of, at worse approximately 1 per 10,000 treatment consultations immediately after cervical spine manipulation, approximately 2 per 10,000 treatment consultations up to 7 days after treatment and approximately 6 per 100,000 cervical spine manipulations. Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse approximately 16 per 1000 treatment consultations. Up to 7 days after treatment, these risks were headache in, at worse approximately 4 per 100, numbness/tingling in upper limbs in, at worse approximately 15 per 1000 and fainting/dizziness/light-headedness in, at worse approximately 13 per 1000 treatment consultations.


CONCLUSIONS
Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.
Thiel
Haymo W
HW
Department of Research and Professional Development, Anglo-European College of Chiropractic, Bournemouth, United Kingdom. hthiel@aecc.ac.uk
Bolton
Jennifer E
JE
Docherty
Sharon
S
Portlock
Jane C
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects*; D020393:Manipulation, Spinal / Q000009:adverse effects; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D019547:Neck Pain / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors