BACKGROUND. Spinal manipulation is a noninvasive manual procedure applied to specific body tissues with therapeutic intent. Although spinal manipulation is commonly used in children, there is limited understanding of the pediatric risk estimates.
OBJECTIVE. Our goal was to systematically identify and synthesize available data on adverse events associated with pediatric spinal manipulation.
METHODS. A comprehensive search was performed of 8 major electronic databases (eg, Medline, AMED, MANTIS) from inception to June 2004 irrespective of language. Reports were included if they (1) were a primary investigation of spinal manipulation (eg, observation studies, controlled trials, surveys), (2) included a study population of children who were aged 18 years or younger, and (3) reported data on adverse events. Data were summarized to demonstrate the nature and severity of adverse events that may result rather than their incidence.
RESULTS. Thirteen studies (2 randomized trials, 11 observational reports) were identified for inclusion. We identified 14 cases of direct adverse events involving neurologic or musculoskeletal events. Nine cases involved serious adverse events (eg, subarachnoidal hemorrhage, paraplegia), 2 involved moderately adverse events that required medical attention (eg, severe headache), and 3 involved minor adverse events (eg, midback soreness). Another 20 cases of indirect adverse events involved delayed diagnosis (eg, diabetes, neuroblastoma) and/or inappropriate provision of spinal manipulation for serious medical conditions (ie, meningitis, rhabdomyosarcoma).
CONCLUSIONS. Serious adverse events may be associated with pediatric spinal manipulation; neither causation nor incidence rates can be inferred from observational data. Conduct of a prospective population-based active surveillance study is required to properly assess the possibility of rare, yet serious, adverse events as a result of spinal manipulation on pediatric patients.
Comments
Flawed paper stirs a profession.
Chiropractic is at times a very nervous profession. Especially unnerving is a paper that addresses a serious subject, necessary in its execution, flawed in its production.
A meta-analysis such as this simply re-states the flaws of other studies; work done by others of dubious merit.
Dubious merit because there is no examination of the uniformity of interventions administered in the studies which they categorise at "spinal manipulation". Examination of a procedure surely deliniates that procedure in detail and presents it to the reader. Just what is "pediatric spinal manipulation"?
This study is what it is: a precurser to the study being rightly done. Lets just see what the adverse effects are of this procedure which seems to define chiropractors. But first, define the procedure, and don't make any serious assumptions until that scientific method is applied properly.
This may sound unbelievable, but In my experience (over a decade) of adjusting hundreds of children there has not been one event that could be categorised as "adverse". Similarly, in communication with my profession and state boards here in Australia, I do not think that one solitary action of litigation against a chiropractor has been brought for seriously harming or death of a child in administrering care. Is this not an astounding statistic in comparison with proper medical paediatric care? Bring on the science, please.
Conflict of Interest:
Registered Chiropractor educated in University-based undergraduate paediatric chiropractic and post- graduate specialisation in upper cervical chiropractic.
Lack of Data Regarding Pediatric Manipulation
Many pieces of the picture are missing in this article. What were the methods of "manipulation" used on these children? How old were the children? What were the symptoms that they presented with? Were these pre-existing conditions? How much force was used in the manipulation? Was this simply "manipulation" performed, or a Chiropractic "adjustment?" There is too much data missing for this to be considered a reputable study.
Conflict of Interest:
I am a chiropractor who adjusts children.