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Letters and Responses |
"Manipulation of the Cervical Spine: Risks and Benefits" by Di Fabio1 (January 1999) addressed a very important and controversial topic. We would like comment on the method of literature review. One purpose of the article was "to review previously reported cases in which injuries were attributed to [manipulation of the cervical spine]."1(p50) On the basis of the literature review, "several recommendations for future studies and for the practice of manipulation of the cervical spine are discussed."1(p50) The author reviewed 116 articles that globally described 177 cases and cited 210 references. It is surprising that, for such a huge effort, the author did not use the commonly used MEDLINE.2 It must be noted that the term "manipulation" was not included in the researched key words, and this is the main topic of the article (in fact, the term is included in the title and in the key words of the article).
This may be the reason of the lack of some papers on this issue. We reported on 4 patients with cervical myelopathy caused or aggravated by cervical spinal manipulation.3,4 It is important to note that, in one of these cases, cervical magnetic resonance imaging was available before and after manipulation.
Along with others in the evidence-based medicine community,2 we believe that literature reviews must be performed exhaustively, using sensitive tools that now are easily available. This is essential, particularly when the purpose is to provide guidelines or recommendations for professional practice. In these cases, a complete and impartial review must be performed, as it usually is in secondary publications.
Institute of Neurology and Orthopaedics
Universitá Cattolica
Fondazione Pro Iuventute
Don C Gnocchi
Rome, Italy
References
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