Review of Severe Adverse Events From Spinal Manipulative Therapy of the Lumbopelvic Area
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Hollis H. King
Hebert JJ, Stomski NJ, French SD, Rubinstein SM. Serious adverse events and spinal manipulative therapy of the low back region: a systematic review of cases [published online June 20, 2013]. J Manipulative Physiol Ther.2013. doi:10.1016/j.jmpt.2013.05.009.
In a recent systematic review, Australian researchers searched the literature for case reports that described severe adverse events of the lumbopelvic area that occurred after spinal manipulative therapy (SMT). The authors reviewed only case reports to gather and describe case details and make recommendations for future case reporting.
The authors found 41 case studies that described 77 separate cases. They noted that important case details were frequently omitted in the articles, such as the type of SMT used, the pre-SMT presentation of the patient, and the actual adverse event that occurred.
The most common serious adverse events reported were cauda equina syndrome (38% of cases) and lumbar disk herniation (30%). Other adverse events included fracture (9%), hematoma or hemorrhagic cyst (8%), and other events (eg, neurologic or vascular complications, soft tissue trauma, muscle abscess, disrupted fracture healing, esophageal rupture) (16%). The authors were not able to estimate an occurrence rate from case report findings alone, but they gave the opinion that lumbopelvic SMT was associated with a lower rate of serious adverse events than cervical spine SMT. One of the 77 cases reported a serious adverse event as a result of osteopathic manipulative treatment (OMT), and that case of paraplegia was from 1945.1 In addition, 1 case reported an adverse event of iliopsoas hematoma with femoral neuropathy after osteopathic manipulative therapy was performed by an osteopath from the United Kingdom.2
The authors indicated that in all of the prospective studies they reviewed, few serious adverse events were reported. Of note, the recently published OSTEOPATHIC Trial,3 which revealed statistically significant benefit of OMT for low back pain, reported adverse events (ie, mild, time-limited complaints) in 27 of 455 participants (6%) and serious adverse events in 9 participants (2%), “none of which was definitely or probably related to a study intervention.”
In my opinion, the application OMT in health care has produced exceedingly few serious adverse events, and the American Osteopathic Association is justified in the position that OMT is safe.
References
1 Poppen JL . The herniated intervertebral disk: an analysis of 400 verified cases. N Engl J Med.1945;232(8):211-215.10.1056/NEJM194502222320801Suche in Google Scholar
2 Stewart-Wayne EG . Iatrogenic femoral neuropathy. Br Med J.1976;1(263):263.10.1136/bmj.1.6004.263Suche in Google Scholar PubMed PubMed Central
3 Licciardone JC Minotti DE Gatchel RJ Kearns CM Singh KP . Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med.2013;11(2):122-129. doi:10.1370/afm.1468.10.1370/afm.1468Suche in Google Scholar PubMed PubMed Central
© 2014 The American Osteopathic Association
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- 2013 BIOM Abstracts and Poster Competition
- Editorial
- Our Past, Present, and Future Are in Our Hands
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- Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: An Illustration of Osteopathic Semantic Confusion
- Original Contribution
- The Persistence of Lumbar Somatic Dysfunction and Its Association With Bone Mineral Density
- Medical Education
- Patterns of Misrepresentation of Clinical Findings on Patient Notes During the COMLEX-USA Level 2-PE
- Special Communication
- A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
- A Research Primer, Part 2: Guidelines for Developing a Research Project
- Case Report
- A Case of Seasonal Recurrent Myopericarditis
- A Case of Idiopathic Colonic Varices
- The Somatic Connection
- OMT Relieves Severe Chronic Low Back Pain
- Abdominal Muscles Are the Front Side of the Low Back
- Systematic Review Paints Incomplete Picture of OMT Research
- Manual Therapy or Exercise Effective for Hip or Knee Osteoarthritis
- Review of Severe Adverse Events From Spinal Manipulative Therapy of the Lumbopelvic Area
- A Chiropractic Perspective: Spinal Manipulative Therapy Is Not Causally Related to Stroke
- Clinical Images
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Artikel in diesem Heft
- Abstracts
- 2013 SOMA Abstracts and Poster Competition
- 2013 BIOM Abstracts and Poster Competition
- Editorial
- Our Past, Present, and Future Are in Our Hands
- Letters
- Osteopathic Manual Treatment and Ultrasound Therapy for Chronic Low Back Pain: An Illustration of Osteopathic Semantic Confusion
- Original Contribution
- The Persistence of Lumbar Somatic Dysfunction and Its Association With Bone Mineral Density
- Medical Education
- Patterns of Misrepresentation of Clinical Findings on Patient Notes During the COMLEX-USA Level 2-PE
- Special Communication
- A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
- A Research Primer, Part 2: Guidelines for Developing a Research Project
- Case Report
- A Case of Seasonal Recurrent Myopericarditis
- A Case of Idiopathic Colonic Varices
- The Somatic Connection
- OMT Relieves Severe Chronic Low Back Pain
- Abdominal Muscles Are the Front Side of the Low Back
- Systematic Review Paints Incomplete Picture of OMT Research
- Manual Therapy or Exercise Effective for Hip or Knee Osteoarthritis
- Review of Severe Adverse Events From Spinal Manipulative Therapy of the Lumbopelvic Area
- A Chiropractic Perspective: Spinal Manipulative Therapy Is Not Causally Related to Stroke
- Clinical Images
- Abducens Palsy
- In Your Words
- No Place Like HOME
