Is systematic radiography needed before spinal manipulation?

Ann Readapt Med Phys. 2007 Mar;50(2):111-6; discussion 117-8. Epub 2006 Oct 19.

[Is systematic radiography needed before spinal manipulation? Recommendations of the SOFMMOO] [Article in French]

Maigne JY, Goussard JC, Dumont F, Marty M, Berlinson G; Société franşaise de médecine manuelle orthopédique et ostéopathique (SOFMMOO).

Service de médecine physique, Hôtel-Dieu de Paris, 1, place du Parvis de Notre-Dame, 75181 Paris cedex 04, France. jy.maigne@htd.aphp.fr

Comment in:

Ann Readapt Med Phys. 2007 Oct;50(7):629-30; author reply 630.

OBJECTIVES: The French National Health Authority recommends systematic radiography before lumbar manipulation. However, current research shows radiography to have more disadvantages than advantages. For the cervical spine, in cases of complication following cervical manipulation, the lack of prior radiography is a fault, even if such x-ray results would have advised manipulation.To establish clear recommendations on this topic, we searched in the literature for complications of spinal manipulations that could have been prevented had preliminary radiography been performed to determine whether these complications were anticipated or not by the international guidelines. MATERIAL AND METHODS: Literature search.

RESULTS: For the lumbar and thoracic spine, the international guidelines are sufficient, except in cases of aneurysmal bone cyst, which can appear until the age of 25 years. For the cervical spine, despite a lack of data in the literature, prudence and medicolegal issues justify the performance of systematic radiography.

CONCLUSION: The SOFMMOO recommends systematic radiography prior to cervical manipulation and in case of back or neck pain in patients of less than 25 years of age. In all other cases, the international guidelines provide sufficient recommendations.


Dr. Darryl Roundy

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