Adverse events associated with the use of cervical manipulation or mobilization and patient characteristics: a systematic review

Rik Kranenburg, M.A. Schmitt, Gert Jan Luijckx, E.J. Puentedura, Cees van der Schans

Abstract

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.
Original languageEnglish
Pages (from-to)32-38
JournalMusculoskeletal science and practice
Volume28
DOIs
StatePublished - Apr 2017
EventInternational Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) Conference 2016 - Glasgow, United Kingdom

Fingerprint

Spinal Manipulation
Dissection
Neck Pain
Chiropractic
Headache

Keywords

  • cervical arterial dissection
  • cervical manipulation
  • cervical mobilization

Cite this

Kranenburg, Rik; Schmitt, M.A.; Luijckx, Gert Jan; Puentedura, E.J.; van der Schans, Cees / Adverse events associated with the use of cervical manipulation or mobilization and patient characteristics : a systematic review.

In: Musculoskeletal science and practice, Vol. 28, 04.2017, p. 32-38.

Research output: Scientific - peer-reviewReview article

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year = "2017",
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journal = "Musculoskeletal science and practice",
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Adverse events associated with the use of cervical manipulation or mobilization and patient characteristics : a systematic review. / Kranenburg, Rik; Schmitt, M.A.; Luijckx, Gert Jan; Puentedura, E.J.; van der Schans, Cees.

In: Musculoskeletal science and practice, Vol. 28, 04.2017, p. 32-38.

Research output: Scientific - peer-reviewReview article

TY - JOUR

T1 - Adverse events associated with the use of cervical manipulation or mobilization and patient characteristics

T2 - Musculoskeletal science and practice

AU - Kranenburg,Rik

AU - Schmitt,M.A.

AU - Luijckx,Gert Jan

AU - Puentedura,E.J.

AU - van der Schans,Cees

PY - 2017/4

Y1 - 2017/4

N2 - 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.

AB - 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.

KW - cervical arterial dissection

KW - cervical manipulation

KW - cervical mobilization

KW - fysiotherapie

KW - nekklachten

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DO - 10.1016/j.msksp.2017.01.008

M3 - Review article

VL - 28

SP - 32

EP - 38

JO - Musculoskeletal science and practice

JF - Musculoskeletal science and practice

SN - 2468-8630

ER -