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The potential for injury to the paediatric spine through the inappropriate or unnecessary use of spinal manipulation. Includes reported injuries.
"The furore surrounding a chiropractor accused of fracturing a baby's neck gathered momentum today with claims the investigation was flawed...Spinal surgeon Mr John Cunningham said he and his colleagues had no doubt the child suffered a fracture..."I strongly suspect that the injury was through the congenital defect, the weak point, which would have contained cartilaginous tissue. This would not be visible on the initial CT as cartilage is simply not seen. A second CT, performed some weeks later [see paragraph 34 of the report], clearly indicates new bone formation and healing of a concurrent fracture." Mr Cunningham said the CAA [Chiropractors' Association of Australia] must have appreciated the significance of the second CT scan. "What I find disingenuous is the manner in which they only released to the press the first CT report," he added." Medical Observer (18th October 2013)
"The peak body representing chiropractors says a Melbourne doctor's claim that an infant's neck was broken during a chiropractic treatment last year is wrong. However, the paediatrician involved, Dr Chris Pappas, has stood by his diagnosis of the baby's injury and said a thorough investigation excluded any other possible causes...national president of the Chiropractors' Association of Australia Dr Laurie Tassell said an expert report on the case commissioned by the Australian Health Practitioner Regulation Agency (AHPRA) and cited in The Australian showed the baby's neck had not been broken. In a written statement, Dr Tassell said the baby had a condition known as congenital spondylolysis, a malformation of the spine that ''can be confused with a 'hangman's fracture'.'' Dr Tassell declined to be interviewed or to comment on whether he had a copy of the report, but said the chiropractor who treated the infant had not applied sufficient force to cause a fracture." Julia Medew, The Age (17th October 2013)
A baby's neck has been broken by a chiropractor in an incident doctors say shows the profession should stop treating children. The injury was reported to the Chiropractic Board of Australia, which closed the case without reporting it to the public and allowed the chiropractor to keep practising as long as they undertook education with an ''expert in the field of paediatric chiropractic". (The Sun-Herald has also seen evidence that chiropractors have been entering Sydney hospitals, including neo-natal intensive care wards and surgical wards, to treat patients without the required permission. NSW Health has warned that any chiropractor working in a hospital without permission could put patients at risk, while the Australian Medical Association NSW says the behaviour is "outrageous".) Melbourne paediatrician Chris Pappas cared for a four-month-old baby last year after one of her vertebrae was fractured during a chiropractic treatment for torticollis - an abnormal neck position that is usually harmless. He said the infant was lucky to make a full recovery. ''Another few millimetres and there would have been a devastating spinal cord injury and the baby would have either died or had severe neurological impairment with quadriplegia,'' he said. Dr Pappas complained to the Australian Health Practitioner Regulation Agency, which referred the case to the Chiropractic Board. Three weeks ago, he received a letter from AHPRA saying the case had been closed after the chiropractor committed to completing further education. Dr Pappas said he was concerned the decision was an endorsement of chiropractic treatment for infants when there was no scientific evidence to support it. ''I think they have put the chiropractor's interests before the interests of the public,'' Dr Pappas said. ''[Treating infants] is inappropriate and it carries a very small but real risk of causing damage, and in some cases, devastating damage.'' Julia Medew, Amy Corderoy, Sydney Morning Herald (29th September 2013)
"We report on a 21-day-old infant with healing posterior rib fractures that were noted after a chiropractic visit for colic. Chiropractors are the third largest group of health care professionals in the United States, and colic is the leading complaint for pediatric chiropractic care. Rib fractures, specifically when posterior, are traditionally considered to be secondary to nonaccidental trauma. Thorough investigation is necessary to rule out bone fragility and genetic disorders, but patient history is key when evaluating unexplained fractures.” Pediatrics. 2012 Nov;130(5):e1359-62.
"Most of the articles identified in this literature review did not use terminology consistent with the standards established by the ICH [International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use] when reporting on safety incidents following pediatric spinal manipulation or chiropractic manipulative therapy." J Manipulative Physiol Ther. (27th August 2012)
“If the history is suspicious for dissection (head and neck trauma, recent cervical
chiropractic manipulation…)” Curr Treat Options Neurol (December 2011)
The objective of this study was to describe the practice of pediatric chiropractic, including its safety and effectiveness. The indicated primary reason for chiropractic care of children was "wellness care”…Chiropractor responders indicated three adverse events per 5,438 office visits from the treatment of 577 children. The parent responders indicated two adverse events from 1,735 office visits involving the care of 239 children. Explore (NY) (Sep-Oct 2009)
“Objective: To update the clinical research literature from the 2007 report by Vohra, Johnston, Cramer and Humphreys on possible adverse events in children treated by spinal manipulation. Conclusions: There is currently insufficient research evidence related to adverse events and manual therapy.” B. Kim Humphreys, Chiropractic & Osteopathy (2010)
“Once the numerator (number of adverse events) and denominator (number of treatments) are known, potential adverse events with chiropractic can be put into context, relative to risks associated with other therapies, such as adverse events due to medications or surgery. The risk:benefit ratio can only be considered if data on both efficacy and harm are collected; at present, in children, neither is substantive. Ultimately, these data are needed so that paediatric patients, their families and their healthcare providers can better evaluate ‘what’s the harm’ with respect to children and chiropractic.” Sunita Vohra MD, Focus on Alternative and Complementary Therapies [FACT] (March 2004)
Includes a statement of concern to the Canadian public from Canadian neurologists regarding the debilitating and fatal damage manipulation of the neck may cause to the nervous system. Concern No.5 strongly recommends "the immediate banning of all spinal manipulation of infants and children". Brad Stewart, MD, Chirobase (2002)
Click here for a PDF copy of the Canadian Neurologists' statement (including the list of signatories)
"Unnecessary or inappropriate use of spinal manipulation in the case of a small child might damage the child's cartilaginous growth centers. Backache is not common in small children and might be a sign of a potentially serious illness. There is no reason to believe that chiropractic adjustments are effective for treating such ailments as ear infection, colic, bedwetting, sleeping problems, asthma, eczema, and so on. While most ailments of this type in children are self-limiting, they should be treated by pediatricians and not by chiropractors." Samuel Homola, DC (Chirobase)
"The incidence of subtle growth plate fractures following high-velocity techniques in children is surely under-appreciated because of the occult nature of these injuries… Despite the seemingly 'plastic' osseous component of the child's vertebrae, the cartilaginous growth plates have been shown, in both humans and other large mammals, to be the primary sites of mechanical energy absorption during trauma. The potential for acquired growth plate injuries is very real, and for this reason, it is important that the physician trained in spinal manipulation be acquainted with the structural and functional differences between individuals of different skeletal ages. Awareness of such dissimilarities may persuade the physician to treat the pediatric spine more conservatively than the adult spine in an effort to avoid damaging the cartilaginous growth mechanisms…. Although there has not been a definite cause-and-occurence relationship established between spinal manipulation in children and growth plate injuries, the potential for growth plate fractures and other subtle injuries of the pediatric spine, including facet avulsion or dislocation, must be appreciated by the physician utilizing manipulation as a manual therapy modality. This might avoid creating irreversible injury that may not be initially recognized… The overall incidence of total injuries sustained from manipulation of the adult spine are underestimated. It is therefore likely that growth plate injuries in children following spinal manipulation are substantially underestimated." Michael L. O'Neal, DO, Assistant Professor, Department of Family Medicine, University of South Florida College of Medicine (Comprehensive Therapy 2003) [pdf]
Researchers found 14 significant injuries, 9 of which were serious, and 2 children died. In one of the fatal cases, the child died from a brain hemorrhage after receiving a neck manipulation; in the other, the child died after a suspected neck fracture. Some children suffered paralysis, while others had less serious or minor problems, such as severe headache and back pain. A chiropractor performed the adjustments in most cases. The reviewers commented that despite the fact that spinal manipulation is widely used on children, paediatric safety data are virtually non-existent. Sunita Vohra MD FRCPC MSc Bradley C. Johnston ND Kristie Cramer MSc and Kim Humphreys DC PhD Pediatrics (January 2007)
NOTE: The article did not consider harmful aspects of chiropractic care that are far more common than the reported events. These include (a) decreased use of immunisation due to misinformation given to parents, (b) psychologic harm related to unnecessary treatment, (c) psychologic harm caused by exposure to false chiropractic beliefs about "subluxations" and (d) financial harm due to unnecessary treatment.
"Few serious harmful events stemming from spinal manipulation in children have been reported compared to the number of manipulations delivered", says new University of Alberta research. Study co-author Dr. Sunita Vohra, associate professor of pediatrics at the University of Alberta and director of the Complementary and Alternative Research Education Program (CARE) at the Stollery Children's Hospital said "The question we pose is, 'are these events truly rare, or are they under-reported?'" The research team identified 14 cases of direct adverse events involving neurological or musculoskeletal events. Nine cases involved serious adverse events such as hemorrhage or paraplegia, two cases reported moderate adverse events requiring medical attention such as severe headache and three involved minor adverse events such as mid-back soreness. Medical News Today (26th May 2006)
An infant with congenital torticollis (twisted neck) underwent chiropractic manipulation, and within a few hours had respiratory insufficiency, seizures, and quadriplegia. Journal of Pediatrics (February 1992)
"Passive stretching of the cervical spine during chiropractic maneuvers may lead to vertebral artery thrombosis with subsequent embolization into the basilar artery circulation." Neurology (1978)