Spinal Manipulation Therapy (SMT) occasionally triggers professional malpractice litigation. Chiropractors and osteopaths are by far the most prolific spinal manipulators and are the most commonly sued.
Detailed guidelines include extensive lists of contra-indications and cautions.
Topics addressed by specific guidelines:
Antagonism between chiropractors and medical practitioners has spawned medical research which suggests that this form of treatment has at least short-term symptomatic benefit for only a minority of patients with headache or neck pain.
Chiropractic academics have countered that the risks of Non Steroidal Anti Inflammatory Drugs (NSAIDs) such as Ibuprofen are many times greater than the very occasional serious complication following SMT.
There is general agreement that manipulation of the neck is much riskier than low back.
Although systematic review of the literature suggests the complication rate is as low as 5-10 per million manipulations, , the remote risk of death or serious neurological damage must be balanced against the perceived benefits.
The majority of cases which have been successfully litigated involve damage to one of the vertebral arteries following Cervical Manipulation Therapy. Even though interconnections between the 2 vertebral and the 2 carotid arteries generally protect the brain from compromise to any 1 vessel, some areas are more vulnerable to vertebral artery injury, resulting in characteristic patterns of stroke.
Such VertebroBasilar Artery (VBA) damage occurs most commonly after rotatory manipulation, and physicians have been cautioned against referring to practitioners of this technique. See associated "Health Watch" link.
Features favouring successful litigation:
VertebroBasilar Artery damage
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