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LETTER
Osteopathy, Chiropractic, and Spinal Manipulation
Michael A. Patmas
15 April 1993 | Volume 118 Issue 8 | Pages 651-653
TO THE EDITOR:
Shekelle and colleagues [1] suggest that the risk of spinal manipulation is low because they could only identify nine reports of manipulation-related complications. In 1985, I identified 33 separate reports of various injuries caused by chiropractic spinal manipulation (Table 1).
Over a 3-year period in a general medical practice, Livingston [2] examined 676 patients with back pain. Of these, 172 (25%) had seen a chiropractor previously, and 12 (7%) had received some sort of injury, primarily to soft tissue. Of greater concern are the more than 40 reported cases of brain or spinal cord infarction associated with chiropractic manipulation [3]. In 1981, the Members of the Stroke Council of the American Heart Association were surveyed and related 360 cases of stroke associated with manipulation [4]. Before spinal manipulation can be generally recommended, studies specifically addressing these risks are needed.
1. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH. Spinal manipulation for low-back pain. Ann Intern Med. 1992; 117:590-8.
2. Livingston MC. Spinal manipulation causing injury. A three year study. Clin Orthop. 1971; 81:82-6.
3. Sherman DG, Hart RG, Easton JD. Abrupt change in head position and cerebral infarction. Stroke. 1981; 12:2-6.
4. Robertson JT. Neck manipulation as a cause of stroke. Stroke. 1982; 13:260-1.
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