Adverse Effects of Spinal Manipulation: A Systematic Review
1.3 Complications per 100,000 Treatments
SOURCE
https://pmc.ncbi.nlm.nih.gov/articles/PMC1905885/
REFERENCE
117
NICE
REFERENCE
123
organisation
Journal of the Royal Society of Medicine
TITLE
Adverse Effects of Spinal Manipulation: A Systematic Review
1.3 Complications per 100,000 Treatments
SOURCE
https://pmc.ncbi.nlm.nih.gov/articles/PMC1905885/
DISC COMMENTARY
This widely-discussed systematic review attempted to catalogue reported serious adverse events following spinal manipulation, drawing mainly on published case reports. Its methodology has since been debated by other researchers, and later reviews have added further context on how often such serious events actually occur.
What was studied?
The review compiled published case reports of serious adverse events following spinal manipulation. A critique by Bolton and Thiel argued it applied evidence indiscriminately, without transparent criteria for causation.
What did they find?
A closely related earlier review by the same author found an estimated 1.3 serious vertebrobasilar complications per 100,000 chiropractic treatments in patients under 45 within a week of treatment, with no significant association in patients over 45.
Why it matters
This review, and the debate around it, is directly relevant to an honest conversation about safety: serious complications from neck manipulation are recognised as possible but genuinely rare.
Why we included it
It shows why safety data needs to be judged on the fuller body of evidence, not isolated case reports alone, so genuinely rare risks are kept in accurate, honest proportion.
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What was studied?
The review compiled published case reports of serious adverse events following spinal manipulation. A critique by Bolton and Thiel argued it applied evidence indiscriminately, without transparent criteria for causation.
What did they find?
A closely related earlier review by the same author found an estimated 1.3 serious vertebrobasilar complications per 100,000 chiropractic treatments in patients under 45 within a week of treatment, with no significant association in patients over 45.
Why it matters
This review, and the debate around it, is directly relevant to an honest conversation about safety: serious complications from neck manipulation are recognised as possible but genuinely rare.
Why we included it
It shows why safety data needs to be judged on the fuller body of evidence, not isolated case reports alone, so genuinely rare risks are kept in accurate, honest proportion.