A narrative review published in Chiropractic & Manual Therapies concludes that imaging should be used in compliance with clinical guidelines and sound judgement; it should not be used routinely in chiropractic clinics.
Routine use of imaging in chiropractic clinics has been a contentious issue for a long time. Some chiropractors advocate the use of imaging to improve the treatment of patients while others recommend the use only when it is recommended in current guidelines on imaging. It looks like the considered approach to the use of imaging is winning the debate.
Current evidence recommends that X-ray is used only when diagnosing trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI may be used to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis.
The researchers recommend prudence when using imaging because there is strong evidence of risks with imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms.
The researchers behind the paper in Chiropractic & Manual Therapies reached their conclusions after having carried out a narrative review of relevant papers from PubMed and The Index of Chiropractic literature using the search words ’chiropractic’, ’spinal X-rays’, ’adverse events’, ’imaging risks and benefits’, ’X-ray radiation exposure’ and ’back and neck pain guidelines’.
The study was carried out by Hazel J Jenkins (Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia), Aaron S Downie (Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia), Craig S Moore (Faculty of Health, University of Technology Sydney, Sydney, Australia) and Simon D French (Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia and School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada)
Read the original paper here: https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0217-8