• Jenkins HJ
• Downie AS
• Moore CS
• French SD

• Affiliation / Macquarie University. Faculty of Science and Engineering. Department of Chiropractic
• Affiliation / Queen's University. School of Rehabilitation Therapy
• Affiliation / University of Technology Sydney. Faculty of Health
• Affiliation(G) / Australia / New South Wales / Sydney
• Affiliation(G) / Canada / Ontario / Kingston
• Back Pain
• Diagnostic Imaging
• Guidelines
• Low Back Pain
• Neck Pain
• Open Access Document
• Practice Guidelines as Topic
• X-Rays

The use of routine spinal X-rays within chiropractic has a contentious history. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.

Author keywords: Chiropractic — Spinal X-rays — Clinical guidelines — Appropriate use of imaging — Low back pain — Back pain — Neck pain — Imaging indications

Author affiliations: HJ, ASD, SDF: Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia; CM: Faculty of Health, University of Technology Sydney, Sydney, Australia; SDF: School of Rehabilitation Therapy, Queen's University, Kingston, ON Canada

This abstract is reproduced with the permission of the publisher; click on the above link for free full text. Online access only. PubMed Record