A description of serious adverse events following spinal manipulative therapy for adults with history of spine surgery: a single institution retrospective chart review.

Objectives: The purpose of this study was to describe patient demographics and medical history, clinical care characteristics, and short-term serious adverse events associated with SMT in adults with prior spine surgery.

Methods: This study was a retrospective chart review of adult (at least 18 years of age) patients with any prior spine surgery who underwent SMT between January 2010 and December 2021 at an academic medical center in the United States. Eligible charts were reviewed, and data were extracted and transcribed onto an a priori Microsoft Excel data extraction tool. Adverse events were defined as vertebral artery dissection, cauda equina syndrome, fracture in the location of SMT, or spine surgery hardware failure in the same spinal region of SMT within 10-days following SMT.

Results: A total of 418 unique patient's charts were eligible for review. The mean patient age was 50.6 years. The majority of patients were female (52.6%), White (90.7%), and non-Hispanic (97.8%). The most common types of spine surgeries were lumbar fusion (28.7%), cervical fusion (27.8%), and lumbar discectomy with laminectomy/foraminotomy (34.7%). The median time after surgery to first SMT was 311 days. There were no short-term incidents of vertebrobasilar/cervical artery injury, acute cauda equina, fractures in the same region of SMT application, or hardware failure.

Conclusion: There were no incidents of serious adverse events in the short-term following SMT in individuals with prior spine surgery in this study. Findings from this study aid in evaluating the safety profile of SMT for patients with prior spine surgery. In addition, findings contribute to the development of future high-quality study designs for investigating the clinical effectiveness of SMT in this patient population.