Adverse Events in the Manipulation of Pediatric Patients: Flaws in a Systematic Review

Abstract

To the Editor .— There is no question that the issue of safety in spinal manipulation, as with any medical intervention, needs to be thoroughly addressed if it is to be considered an effective and broadly used modality of health care. That said, numerous articles, often containing numerous methodologic flaws,1–3 together with responses4–6 have appeared in the literature addressing the issue of manipulation (usually cervical) in adults. The recent article by Vohra et al7 was one of the first to attempt to more comprehensively cull the observational studies as well as the randomized clinical trials to date in assessing the safety matter of manipulation as it pertains to children. It correctly stated that there is useful information to be gleaned from the case studies as well as the more rigorous clinical trials. That said, however, there are flaws significant enough to invalidate 2 of the authors’ key objectives: The authors’ claim that they thoroughly searched the literature is threatened in their introduction, where they completely omitted any reference to the clear benefits of spinal manipulation in treating otitis media, as reported in 2 large cohort studies published in the indexed literature by Froehle8 and Fallon and Edelman.9 Of far more gravity, however, is the fact that they reported a series of 14 cases of direct adverse events and that “each case involved a chiropractor and was reported in the United States.” From 1 of the references cited, however, the treating doctor was most decidedly not a chiropractor but, rather, a physical therapist,10 most likely practicing not in …