Index to Chiropractic Literature
Index to Chiropractic Literature
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ID 21281
  Title Prevalence of congenital abnormalities contraindicating spinal manipulative therapy within a chiropractic patient population
Journal Chiropr J Aust. 2010 Jun;40(2):69-76
Peer Review Yes
Publication Type Article
Abstract/Notes Purpose: Despite known risks of spinal manipulative therapy (SMT), current radiographic guidelines do not allow assessment of all potential contraindications to treatment. Congenital or developmental anomalies are often asymptomatic but may represent contraindications to SMT. Congenital and developmental anomalies that are significant to SMT are thought to be quite rare. However, reliable figures for prevalence could not be found for the majority of these anomalies within the literature. Therefore, this research aimed to determine the prevalence rates of various congenital and developmental anomalies within a chiropractic-patient population and hence assess the suitability of current x-ray guidelines for the chiropractic profession.

Methods: A retrospective study was undertaken on 3519 spinal plain-film x-ray reports taken within the Macquarie University Chiropractic Outpatient Clinics from 2000 to 2005. Each report was assessed for the specific spinal regions reported on and the number of congenital or developmental anomalies within that region. Only the anomalies that would contraindicate SMT, or change the treatment approach were collated. Prevalence of each anomaly was calculated per spinal region. Total prevalence of all congenital anomalies per spinal region was also calculated.

Results: The 3519 spinal x-ray reports assessed for congenital anomalies included x-rays of 2814 cervical regions, 695 thoracic regions and 1052 lumbar regions. The total percentage of congenital or developmental anomalies found was 28.5% (cervical spine), 0.7% (thoracic spine) and 18.3% (lumbar spine). The most common anomalies found were posterior ponticles (21.3%), transitional lumbosacral vertebrae (16.64%) and cervical ribs (5.1%).

Conclusion: The prevalence of clinically significant congenital and developmental anomalies in the cervical and lumbar spine is high enough to warrant closer inspection of the current x-ray guidelines. However, the clinical effect that the majority of these anomalies have on treatment is controversial. Radiographic observation of the more common anomalies may not significantly alter the treatment approach depending on the practitioner and type of SMT used. Further research is needed into the effect that these anomalies have with respect to the safety of SMT and the importance that chiropractors attribute to these anomalies within a clinical setting before any change to radiographic guidelines should be proposed.

This abstract is reproduced with the permission of the publisher; full text by subscription.

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