image: UH Cleveland Medical Center
Credit: University Hospitals
A recent study led by researchers at University Hospitals (UH) Connor Whole Health and collaborators at Duke University Medical School examined whether chiropractic spinal manipulation could lead to an increased risk of cauda equina syndrome (CES), a rare but serious condition affecting the bundle of spinal nerve roots in the lower back that requires emergency surgery. The study, titled " Association between chiropractic spinal manipulation and cauda equina syndrome in adults with low back pain: Retrospective cohort study of US academic health centers," was recently published in PLOS One.
Case reports have documented instances of CES occurring after spinal manipulation – a hands-on treatment often used by chiropractors – suggesting that CES could be an adverse event related to this therapy. However, others have argued that this is not a causal association. Prior to now, no large study had investigated this concern.
This retrospective study analyzed medical record data for over 130,000 adult patients from academic medical centers who received either chiropractic spinal manipulation or physical therapy evaluation for low back pain in the United States. The two cohorts were closely matched on demographics and other health factors to make them comparable in terms of baseline risk factors for CES. The study used a follow-up window of 90 days to identify new diagnoses of CES.
The overall CES incidence aligned with prior estimates in people with low back pain, suggesting these patients may have an inherent susceptibility to CES regardless of treatment approach. However, the authors found no meaningful difference in the risk of developing CES between those who received spinal manipulation cohort (0.07%) and those who did not (0.11%).
“Patients with low back pain may have underlying disc degeneration, which can pose a risk for developing CES. Accordingly, clinicians treating low back pain should be aware of CES as a surgical emergency,” said lead author Robert J. Trager.
“This study is the largest and most rigorous investigation regarding the potential association between CES and chiropractic spinal manipulation to date. While more research is needed, these findings offer further support for current low back pain guidelines recommending this treatment approach as first-line care for patients with low back pain,” added co-author Dr. Christine Goertz, Professor at Duke University School of Medicine.
“This study is reassuring regarding the safety of chiropractic care for low back pain” said Dr. Françoise Adan, Chief Whole Health and Wellbeing Officer and Director of UH Connor Whole Health.
Reference:
Trager RJ, Baumann AN, Perez JA, Dusek JA, Perfecto R-PT, Goertz CM. Association between chiropractic spinal manipulation and cauda equina syndrome in adults with low back pain: Retrospective cohort study of US academic health centers. PLOS ONE. 2024;19:e0299159.
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About University Hospitals / Cleveland, Ohio
Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 21 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University, the Technion Israel Institute of Technology and National Taiwan University College of Medicine. The main campus also includes the UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit UHhospitals.org.
Journal
PLOS One