• Spriggs M
• Foulkes D

• Cervical Vertebrae / diagnostic imaging
• Neck Pain
• Open Access Document
• Radiology
• Radiology / standards

Introduction: Neck pain is a common health complaint in the UK and the second most common complaint seen by chiropractors worldwide. Spinal manipulative therapy (SMT) is an effective treatment intervention for patients with neck pain. The risks of SMT of the cervical spine (cSMT) are well documented in the literature; however, investigations into patient risk factors are lacking. Debate exists within the profession regarding the appropriate use of x-rays for spinal complaints with screening for contraindications to cSMT seen by some as inappropriate. This retrospective review of records and service evaluation examines how frequently lateral cervical spine x-rays alter treatment options in 1 chiropractic practice.

Methods: Data from 626 patient records were retrospectively reviewed from a private chiropractic clinic in the UK. Of the 626 new patients, 293 (47%) had x-rays of their cervical spine before commencing treatment. Patient x-rays and x-ray reports were reviewed for contraindications to cSMT.

Results: Of the 293 cervical spine x-rays, 177 (60%) revealed contraindications to cSMT over the 4 years of data collection. Thus, 28% of the 626 new patients who attended the clinic during that time period had their treatment option altered due to findings of contraindications on lateral cervical spine x-rays. Data analysis found that of those x-rays with contraindications, 46% had more than 1 contraindication present in the same patient. Extrapolating these data to the entire new patient population who attended the clinic, 15% of patients per annum had their treatment options altered as a direct result of x-rays findings.

Conclusion: The study found that 60% of cervical spine x-rays revealed contraindications to cSMT over the entire study period. Approximately 30% of lateral cervical spine x-rays revealed contraindications to cSMT, subsequently altering the treatment options of patients. This study adds supporting evidence to the validity of x-rays in chiropractic clinical practice in reducing risks of adverse events from cSMT and increasing patient safety.

Author keywords: Chiropractic; Cervical Spine; Radiology

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