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The Somatic Connection  |   January 2014
Review of Severe Adverse Events From Spinal Manipulative Therapy of the Lumbopelvic Area
Author Affiliations
  • Hollis H. King, DO, PhD
    University of Wisconsin School of Medicine and Public Health, Madison
Article Information
The Somatic Connection   |   January 2014
Review of Severe Adverse Events From Spinal Manipulative Therapy of the Lumbopelvic Area
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 63-64. doi:10.7556/jaoa.2014.013
The Journal of the American Osteopathic Association, January 2014, Vol. 114, 63-64. doi:10.7556/jaoa.2014.013
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
Poppen JL. The herniated intervertebral disk: an analysis of 400 verified cases. N Engl J Med. 1945;232(8):211-215. [CrossRef]
Stewart-Wayne EG. Iatrogenic femoral neuropathy. Br Med J. 1976;1(263):263. [CrossRef] [PubMed]
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. [CrossRef] [PubMed]