|
|
 |
Chiropractic Safety Research for Doctors
|
Passive Care:
Adjustments - Safety (Disc Herniation)
|
|
Oliphant, D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):197-210.
The objective of this study was to provide a qualitative systematic review of the risk of spinal manipulation in the treatment of lumbar disk herniations (LDH) and to estimate the risk of spinal manipulation causing a severe adverse reaction in a patient presenting with LDH.
Relevant case reports, review articles, surveys, and investigations regarding treatment of lumbar disk herniations with spinal manipulation and adverse effects and associated risks were found with a search of the literature.
Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated.
From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated.
This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH.
RESULTS:
An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million.
CONCLUSION:
The apparent safety of spinal manipulation, especially when compared with other "medically accepted" treatments for LDH, should stimulate its use in the conservative treatment plan of LDH.
Oliphant, D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):197-210.
The safety of spinal manipulation in the treatment of Lumbar Disc Herniations should be compared with other commonly accepted treatments for the same condition.
Comparing this, or any treatment, with "no treatment" is not meaningful, because while no treatment may be the safest option, most patients seeking relief will opt for some type of treatment, hoping it will provide more relief than natural history.
NSAIDs are the most commonly used medications in the world, and adverse events occur in 25% of patients, with significant complications occurring in 1% to 4% per year.
GI complications due to NSAIDs cause more than 100,000 hospitalizations and an estimated 16,500 deaths each year in the United States.
Cauda Equina Syndrome (CES) is reported as a sequela of surgeries for Lumbar Disc Herniation in 0.2% to 1%. The "any-complication rate %" has been estimated to be 3.7% or more, including 1.5% mortality.
The most recent study comparing surgical with non-surgical treatment of chronic LBP patients found 24% of the surgical group had complications, almost half being major complications, and almost 8% required reoperations.
If "significant complications" occur in 1% to 4% of NSAID users, in 1.5% to 12% of LDH surgeries, and in 1 in 3.7 million patients receiving spinal manipulation for LDH, then spinal manipulation is at least 37,000 to 148,000 times safer than NSAIDs and 55,500 to 444,000 times safer than surgery for the treatment of LDH.
If Cauda Equina Syndrome occurs in 1 in 3.7 million spinal manipulations for LDH and in 0.2% to 1% of surgeries, then CES is at least 7400 to 37,000 times more likely to occur as a complication of surgery than of spinal manipulation.
Meanwhile, neither NSAIDs nor surgery has been proven to be more effective in the treatment of LDH than spinal manipulation.
There are no data to support the premise that operative intervention will restore neurologic function more rapidly than natural history or nonoperative intervention.
|
|
|
|
