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Manipulation and Mobilization of the Cervical Spine: A Systematic Review of the Literature

Hurwitz, Eric L., DC, PhD; Aker, Peter D., DC; Adams, Alan H., DC; Meeker, William C., DC, MPH; Shekelle, Paul G., MD, PhD

Cervical Spine

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.

From *RAND, Santa Monica, CA, the Department of Epidemiology, University of California, Los Angeles, School of Public Health, Los Angeles, California; the Canadian Memorial Chiropractic College, Toronto, Ontario; and the §Los Angeles College of Chiropractic, Whittier, CA; Palmer College of Chiropractic-West, San Jose, CA; and West Los Angeles Veterans Affairs Medical Center, Los Angeles, California.

Supported in part by a grant from the Consortium for Chiropractic Research.

Dr. Shekelle is a Research Associate of the Veterans Affairs Health Services Research and Development Service.

All of the conclusions in this paper are those of the authors and do not necessarily reflect the views of RAND or of the Consortium for Chiropractic Research.

Acknowledgment date: January 31, 1995.

First revision date: August 19, 1995.

Acceptance date: November 13, 1995.

Device status category: 1.

Address reprint requests to: Eric L. Hurwitz, DC, PhD; School of Public Health; Department of Epidemiology; 73-318 Center for Health Sciences; University of California, Los Angeles; Los Angeles, CA 90095-1772

Copyright © 1996 Wolters Kluwer Health, Inc. All rights reserved.