Thoracic adverse events following spinal manipulative therapy: a systematic review and narrative synthesis

JOURNAL OF MANUAL & MANIPULATIVE THERAPY, 2020 · DOI: https://doi.org/10.1080/10669817.2020.1725277 · Published: February 12, 2020

Alternative Medicine Healthcare Rehabilitation

Simple Explanation

Spinal manipulative therapy (SMT) is a common treatment for spinal issues, but serious adverse events (AE) in the thoracic area have been reported. This review aims to understand these events. The review found 21 cases of thoracic AE, including spinal cord issues, pneumothorax, fractures, and organ rupture, some leading to permanent deficits or death. While a direct cause cannot be confirmed, the findings emphasize the importance of careful clinical reasoning and pre-examination before performing SMT.

Study Duration

Not specified

Participants

21 unique thoracic AE cases reported in 19 studies

Evidence Level

Level 5 (case studies and case series)

Key Findings

1
Serious thoracic AE including permanent neurological deficit and death have been reported following SMT, even though causality cannot be confirmed.
2
Reported thoracic AE included nonvascular tissue of the spinal cord or dura (n = 7), vascular related to spine (n = 6), pneumothorax or hemothorax (n = 3), fracture (n = 3), esophageal rupture (n = 1), rupture of thoracic aorta (n = 1) and partial pancreatic transection (n = 1).
3
The majority of practitioners involved in the reported adverse events were chiropractors.

Research Summary

This systematic review synthesized evidence of thoracic adverse events (AE) following spinal manipulative therapy (SMT). It included 21 cases published in 19 studies, highlighting instances of AE after SMT. The review found that the most frequently reported thoracic AE involved the spinal cord. Furthermore, reported thoracic AE are severe as opposed to moderate, requiring medical management and surgical interventions. The review emphasizes the importance of clinical reasoning, pre-thrust examination, and careful consideration of contraindications before performing SMT to ensure safe practice.

Practical Implications

Clinical Reasoning

Emphasizes the need for thorough clinical reasoning and pre-thrust examination before SMT.

Reporting Guidelines

Highlights the need for better reporting guidelines for case studies and case series to improve data quality.

Practitioner Training

Suggests the importance of specialist training and experience for practitioners performing SMT.

Study Limitations

1
Low level of evidence (case studies and case series).
2
Poor reporting of included studies due to lack of reporting guidelines for single case studies and case series.
3
Causality between SMT and thoracic AE could not be established.

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