Article

Cervical spine manipulation (CSM) is a commonly utilized
intervention, but its use remains controversial. PURPOSE: To retrospectively
analyze all available documented case reports in the literature describing
patients who had experienced severe adverse events (AEs) after receiving CSM to
determine if the CSM was used appropriately, and if these types of AEs could have
been prevented using sound clinical reasoning on the part of the clinician. DATA
SOURCES: PubMed and the Cumulative Index to Nursing and Allied Health were
systematically searched for case reports between 1950 and 2010 of AEs following
CSM. STUDY SELECTION: Case reports were included if they were peer-reviewed;
published between 1950 and 2010; case reports or case series; and had CSM as an
intervention. Articles were excluded if the AE occurred without CSM (e.g.
spontaneous); they were systematic or literature reviews. Data extracted from
each case report included: gender; age; who performed the CSM and why; presence
of contraindications; the number of manipulation interventions performed; initial
symptoms experienced after the CSM; and type of resultant AE. DATA SYNTHESIS:
Based on the information gathered, CSMs were categorized as appropriate or
inappropriate, and AEs were categorized as preventable, unpreventable, or
unknown. Chi-square analysis with an alpha level of 0.05 was used to determine if
there was a difference in proportion between six categories:
appropriate/preventable, appropriate/unpreventable, appropriate/unknown,
inappropriate/preventable, inappropriate/unpreventable, and
inappropriate/unknown. RESULTS: One hundred thirty four cases, reported in 93
case reports, were reviewed. There was no significant difference in proportions
between appropriateness and preventability, P = .46. Of the 134 cases, 60 (44.8%)
were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%)
were categorized as 'unknown'. CSM was performed appropriately in 80.6% of cases.
Death resulted in 5.2% (n = 7) of the cases, mostly caused by arterial
dissection. LIMITATIONS: There may have been discrepancies between what was
reported in the cases and what actually occurred, since physicians dealing with
the effects of the AE, rather than the clinician performing the CSM, published
many of the cases. CONCLUSIONS: This review showed that, if all contraindications
and red flags were ruled out, there was potential for a clinician to prevent
44.8% of AEs associated with CSM. Additionally, 10.4% of the events were
unpreventable, suggesting some inherent risk associated with CSM even after a
thorough exam and proper clinical reasoning.

Langue : ANGLAIS

Tiré à part : OUI