[Complications following vertebral manipulation-a survey of a French region physicians]. / Evaluation de la fréquence des accidents liés aux manipulations vertébrales à partir d'une enquête rétrospective réalisée dans quatre départements français.

INTRODUCTION: Recent studies have emphasized the incidence and the general underestimation in literature of spinal manipulation (SM) linked accident. The aim of this study was to estimate the frequency and the incidence of strokes, myelopathies, radiculopathies or osteoarticular accidents in a major French area. MATERIAL AND METHOD: We made a survey among 240 neurologists, neurosurgeons, rhumatologists and physicians concerning the number of accidents observed during the preceding two years. RESULTS: We obtained a response from 133 physicians and 93 cases of complication were reported. Most of these complications were radiculopathies (69%). Approximatively 50% occurred at the cervical level, less than 24 hours after SM with or without sligth aftereffects in 68%. The incidence of vertebro-basilar accidents was 30 times higher than in published series. CONCLUSION: Spinal manipulations should remain under very strict medical control. Physicians who practice SM should be able to choose the manual treatment and perform it themselves in order to minimize risks of complications, especially at the cervical level.

[Cervical spine manipulation: risks--benefit--assessment]. / Manipulations du rachis cervical: risques--bénéfices--précautions.

Cervical manipulation is a widely used method indicated in non-specific mechanical neck pain and cervicogenic headache. Cervical manipulation can cause severe neurologic complications which are both rare and generally unpredictable, which can be compared with the accidents occurring with other treatments (nonsteroidal anti-inflammatory drugs...). To decrease this risk, we propose five recommendations developed by consensus: --unwanted effects, however minor (e.g. nausea or vertigo), of prior manipulation should be searched for routinely and taken as contraindications for future spinal manipulations; --a thorough physical examination, including a neurological evaluation should be performed prior to manipulation; --all know indications and contraindications should be followed; -- manipulations should be performed only by physicians experienced in this technique; --special caution should be exercised when performing first-line cervical manipulation and simple, honest and easily understandable information about these risks should be included when informed consent is obtained.