MANIPULATION AND MOBILIZATION OF THE CERVICAL-SPINE - A SYSTEMATIC REVIEW OF THE LITERATURE

Study Design. Cervical spine manipulation and mobilization were review ed in an analysis of the literature from 1966 to the present. Objectiv es. To assess the evidence for the efficacy and complications of cervi cal spine manipulation and mobilization for the treatment of neck pain and headache. Summary of Background Data. Although recent research ha s demonstrated the efficacy of spinal manipulation for some patients w ith low back pain, little is known about its efficacy for neck pain an d headache. Methods. A structured search of four computerized bibliogr aphic data bases was performed to identify articles on the efficacy an d complications of cervical spine manual therapy. Data were summarized , and randomized controlled trials were critically appraised for study quality. The confidence profile method of meta-analysis was used to e stimate the effect of spine manipulation on patients' pain status. Res ults. Two of three randomized controlled trials showed a short-term be nefit for cervical mobilization for acute neck pain. The combination o f three of the randomized controlled trials comparing spinal manipulat ion with other therapies for patients with subacute or chronic neck pa in showed an improvement on a 100-mm visual analogue scale of pain at 3 weeks of 12.6 mm (95% confidence interval, -0.15, 25.5) for manipula tion compared with muscle relaxants or usual medical care. The highest quality randomized controlled trial demonstrated that spinal manipula tion provided short-term relief for patients with tension-type headach e. The complication rate for cervical spine manipulation is estimated to be between 5 and 10 per 10 million manipulations. Conclusions. Cerv ical spine manipulation and mobilization probably provide at least sho rt-term benefits for some patients with neck pain and headaches. Altho ugh the complication rate of manipulation is small, the potential for adverse outcomes must be considered because of the possibility of perm anent impairment or death.