January 2007

Pediatric journal warns
spinal adjustment may be dangerous

Severe adverse events may be associated with pediatric spinal manipulation, according to a study published in Pediatrics (Vol. 119, 1, Jan. 2007). The study was conducted by a group of researchers that included a chiropractor from Canadian Memorial Chiropractic College.

The goal of “Adverse Events Associated with Pediatric Spinal Manipulation: A Systematic Review” was to identify and synthesize available data on adverse events associated with pediatric spinal manipulation.

Researchers culled published literature and included 13 studies (11 observational reports and two randomized trials) and identified 14 cases of direct adverse events involving neurologic or musculoskeletal events. They found:

• Nine cases involving serious adverse events,
• Two involving moderately adverse events that required medical attention,
• Three involving minor adverse events (such as midback soreness), and
• Twenty cases of indirect adverse events involving delayed delayed diagnosis.

The researchers were Sunita Vohra, MD, MSc; Bradley C. Johnston, ND; Kristie Cramer, MSc; and Kim Humphreys, DC, PhD.

In the report they said their study had several limitations:

• Most studies were case reports with limited data;
• Their search strategy for studies did not allow for systematic identification of indirect adverse events, so these events “are likely underestimated;”
• They excluded cases that were only identified in medicolegal proceedings or the lay press.

The researchers concluded that further study on the safety of spinal manipulation for children is needed, and in the meantime, “clinicians should query parents and children about CAM usage and caution families that although serious adverse events may be rare, a range of adverse events or delay in appropriate treatment may be associated with the use of spinal manipulation in children.”

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