What are the clear indications for cervical spinal manipulation?

From the Guidelines

Cervical spinal manipulation is recommended for patients with acute or chronic neck pain, cervicogenic headaches, and certain types of whiplash injuries, where the benefits of manipulation outweigh the risks 1.

Key Considerations

• For maximum benefit, manipulation should be performed by a licensed and experienced practitioner, and the patient should have a thorough medical evaluation to rule out contraindications such as osteoporosis, vertebral artery disease, or recent trauma 1.
• The manipulation should be gentle and controlled, with a specific focus on the affected joints and muscles, and may be combined with other therapies such as exercise, heat, or cold therapy 1.
• In general, a course of 6-12 sessions over 2-6 weeks may be necessary to achieve optimal benefit, with regular reassessment to monitor progress and adjust the treatment plan as needed 1.

Important Contraindications

• It is essential to note that cervical spinal manipulation should not be performed on patients with certain medical conditions, such as rheumatoid arthritis, spinal cord compression, or severe osteoporosis, and should be used with caution in patients taking anticoagulant medications such as warfarin or aspirin 1.
• Patients with a history of spinal fusion or advanced spinal osteoporosis should also be approached with caution, as the risks of spinal manipulation may outweigh the benefits 1.

From the Research

Indications for Cervical Spinal Manipulation

The following are clear indications for cervical spinal manipulation:

• Subacute/chronic neck pain: Moderate quality evidence suggests that manipulation and mobilisation produce similar effects on pain, function, and patient satisfaction at intermediate-term follow-up 2.
• Cervicogenic headache: Low quality evidence shows that manipulation alone compared to a control may provide short-term relief following one to four sessions 2.
• Acute/chronic neck pain: Low quality evidence supports thoracic manipulation as an additional therapy for pain reduction and increased function 2.

Benefits and Risks

The benefits and risks of cervical spinal manipulation are as follows:

• Benefits: Cervical manipulation and mobilisation may provide immediate- or short-term changes in pain and function, but no long-term data are available 2.
• Risks: The risk of injury associated with cervical spinal manipulation appears to be small, but it has the potential to expose patients to vertebral artery damage 3.
• Adverse events: Most reported adverse events are mild, and none are serious or moderate 4.
• Complication rate: The complication rate for cervical spine manipulation is estimated to be between 5 and 10 per 10 million manipulations 5.

Patient Characteristics

Patient characteristics that may be associated with adverse events after cervical spinal manipulation include:

• Gender: Women may be more at risk for cervical arterial dissection 6.
• Age: The mean age of patients experiencing adverse events is around 45 for males and 39 for females 6.
• Treatment process: Manipulation is reported in 95% of cases, and neck pain is the most frequent indication 6.