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Manipulation and mobilization of the cervical spine. A systematic review of the literature.

March 17, 2015

Manipulation and mobilization of the cervical spine. A systematic review of the literature.

AUGUST 10, 1996


Subject: Cervical Spine Related Studies


Reference: Hurwitz EL, Aker PD, Adams AH, Meeker WC,  Shekelle PG. Manipulation and mobilization of the cervical spine: a  systematic review of the literature. Spine 1996; 21(15): 1746-59;  discussion 1759-60


Abstract: STUDY DESIGN: Cervical spine manipulation and mobilization were  reviewed in an analysis of the literature from 1966 to the present.


OBJECTIVES: To assess the evidence for the efficacy and  complications of cervical spine manipulation and mobilization for the  treatment of neck pain and headache.


SUMMARY OF BACKGROUND DATA: Although recent research has  demonstrated the efficacy of spinal manipulation for some patients with  low back pain, little is known about its efficacy for neck pain and  headache.


METHODS: A structured search of four computerized bibliographic  data bases was performed to identify articles on the efficacy and  complications of cervical spine manual therapy. Data were summarized,  and randomized controlled trials were critically appraised for study  quality. The confidence profile method of meta-analysis was used to  estimate the effect of spinal manipulation on patients’ pain status.


RESULTS: Two of three randomized controlled trials showed a  short-term benefit for cervical mobilization for acute neck pain. The  combination of three of the randomized controlled trials comparing  spinal manipulation with other therapies for patients with subacute or  chronic neck pain showed an improvement on a 100-mm visual analogue  scale of pain at 3 weeks of 12.6 mm (95% confidence interval, -0.15,  25.5) for manipulation compared with muscle relaxants or usual medical  care. The highest quality randomized controlled trial demonstrated that  spinal manipulation provided short-term relief for patients with  tension-type headache. The complication rate for cervical spine  manipulation is estimated to be between 5 and 10 per 10 million  manipulations. CONCLUSIONS: Cervical spine manipulation and mobilization  probably provide at least short-term benefits for some patients with  neck pain and headaches. Although the complication rate of manipulation  is small, the potential for adverse outcomes must be considered because  of the possibility of permanent impairment or death.

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