Adverse events associated with the use of cervical spine manipulation or mobilization and patient characteristics: A systematic review.
Cervical spinal manipulation (CSM) and cervical mobilization are frequently used in patients with neck pain and headache. Pre-manipulative cervical instability and arterial integrity tests appear to be unreliable in identifying patients at risk for adverse events. It would be valuable if patients at risk could be identified by specific characteristics during the preliminary screening. Objective was to identify characteristics of 1) patients, 2) practitioners, 3) treatment process and 4) adverse events (AE) occurring after CSM or cervical mobilization. A systematic search was performed in PubMed, Embase, CINAHL, Web-of-science, AMED, and ICL (Index Chiropractic Literature) up to December 2014. Of the initial 1043 studies, 144 studies were included, containing 227 cases. 117 cases described male patients with a mean age of 45 (SD 12) and a mean age of 39 (SD 11) for females. Most patients were treated by chiropractors (66%). Manipulation was reported in 95% of the cases, and neck pain was the most frequent indication. Cervical arterial dissection (CAD) was reported in 57% (P = 0.21) of the cases and 45.8% had immediate onset symptoms. The overall distribution of gender for CAD is 55% (n = 71) for female and therefore opposite of the total AE. Patient characteristics were described poorly. No clear patient profile, related to the risk of AE after CSM, could be extracted. However, women seem more at risk for CAD. There seems to be under-reporting of cases. Further research should focus on a more uniform and complete registration of AE using standardized terminology.
Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands. Electronic address: h.a.kranenburg@pl.hanze.nl.
H A
HA
Kranenburg
Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
M A
MA
Schmitt
University of Nevada Las Vegas, School of Allied Health Sciences, Department of Physical Therapy, Las Vegas, NV, USA.
E J
EJ
Puentedura
University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.
G J
GJ
Luijckx
Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Rehabilitation, Groningen, The Netherlands.
C P
CP
van der Schans
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000503:physiopathology*; D005260:Female; D006261:Headache / Q000209:etiology*; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects* / Q000379:methods*; D020393:Manipulation, Spinal / Q000009:adverse effects* / Q000379:methods*; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology*; D013122:Spinal Diseases / Q000628:therapy*; D016896:Treatment Outcome
Adverse event; Cervical arterial dissection; Cervical manipulation; Cervical mobilization