Award Date


Degree Type


Degree Name

Doctor of Physical Therapy (DPT)


Physical Therapy

First Committee Member

Louie Puentedura

Second Committee Member

Merrill Landers

Number of Pages



Objectives: Documented case reports found in medical literature describing adverse events associated with cervical spine manipulation (CSM) were reviewed to determine if the CSM was used appropriately and if the events could have been prevented. Our hypothesis was that CSM had been used inappropriately and that adverse events could have been prevented. This study also looked to identify potential characteristics that may put the patient at risk for injury, or even death as a result of a CSM.

Methods: One hundred and thirty four cases, reported in 93 articles, published between 1950 and 2010, were reviewed. CSMs were categorized as 'appropriate' or 'inappropriate', and adverse events associated with the CSM were categorized as 'preventable', 'unpreventable' or 'unknown'.

Results: Chi square analysis showed no significant difference in proportions between appropriateness and preventability, p=.459. Of the 134 cases, 60 (44.8%) were categorized as preventable, 14 (10.4%) were unpreventable and 60 (44.8%) were categorized as ‘unknown’. CSM was performed appropriately in 80.6% of cases. Death resulted in 5.2% (n=7) of the cases, mostly caused by arterial dissection.

Discussion: There is no association between appropriateness of cervical manipulation and preventability of adverse events. If all contraindications and red flags have been ruled out, there is potential for a clinician to prevent 44.8% of adverse events. Additionally, 10.4% of the events were unpreventable, suggesting there may be some inherent risk associated with CSM even after a thorough exam and proper clinical reasoning.


Cervical; Cervical vertebrae; Chiropractic; Manipulation (Therapeutics); Physical therapy; Safety; Spinal adjustment


Alternative and Complementary Medicine | Physical Therapy

File Format


Degree Grantor

University of Nevada, Las Vegas




Incomplete paper data


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