Comparing the Risks: Spinal Manipulation versus Back Surgery 

 April 27, 2012

By  Dr. Tripp Stover, D.C.

At Stover Chiropractic, P.C., I’ve noticed most people seeking help for back or neck pain recognize that they may have treatment options (often including chiropractic care and surgery), many do not understand the potential benefits and risks associated with those choices.  Patients who ask family, friends or coworkers for advice all too often hear secondhand stories about healthcare “miracles” or “nightmares” experienced by a friend’s uncle, a wife’s boss or a father’s golfing buddy.  The clinical facts—on the other hand—are often less accessible to the average person and tend to leave a smaller impression.   However, for those who want a broader perspective on their treatment options, there are several high-quality research resources available.  The American Journal of Medicine and Spine (among others) have featured information on the risks involved with surgery and spinal manipulation.

Headline:  Both Surgery and Manipulation Present Risks

Patients who are suffering with neck pain and considering both surgery and chiropractic treatment should be aware of the risks and discuss them openly with their healthcare providers.

In the case of any surgery, there may be serious complications from anesthesia, excessive bleeding, blood clots that lead to pulmonary embolism and infection.  These general risks are added to the more specific risks of surgery on the spine.  These may include a dural tear (the dura surrounds the spinal cord and a tear can cause leaking of cerebrospinal fluid), spinal cord injury and persistent or increased pain from an unsuccessful procedure.

Spinal manipulation may also cause dangerous complications.  Spinal manipulation has been associated with disc herniation, cauda equina syndrome (pain, weakness or loss of bladder and bowel function) and vertebrobasilar accident (a tear in a major artery of the neck).  These complications can be just as serious as the complications associated with surgery.

If similarly severe complications may result from either course of treatment, how can a patient weigh the risk of each option?  Managing risk isn’t just about understanding “worst-case”-type scenarios, it’s also about understanding how likely these and other complications are to occur.  This is where some additional research findings can help.

How Frequently Do Serious Complications Actually Occur?

In April 2010, the journal Spine (published by Lippincott Williams & Wilkins) included an article that summarized the incidence of adverse events in spinal surgery based on the authors’ review and analysis of the existing literature.  They found complication rates for spinal surgery ranging from 5% to 19%.  Similarly, the American Journal of Medicine in 2002 published the results of a study that examined the incidence of serious adverse events for spinal manipulation.  By comparison, researchers involved in that work reported complication rates ranging from one out of every 400,000 manipulations to one out of every two million.

So now we can see that the risk of a serious adverse event from spinal manipulation is extremely low relative to the risk posed by surgery.  That’s one reason that the Mayo Clinic and many other reliable healthcare organizations around the world consider spinal manipulation very safe when performed by someone trained and licensed to provide this type of chiropractic care.

Whenever we talk about risk, it’s always important to remember that almost everything we do can be ‘associated’ with some type of adverse event.  Driving a car, handling scissors, and even eating dinner can all lead to serious complications.  The best way to handle these risks, including the risks of spinal manipulation, is to understand them and keep them in perspective.  Healthcare providers are uniquely qualified to help you do that.  If you or someone you care about is interested in chiropractic care—including its potential benefits and risks—please call our office to make an appointment.


Dekutoski, MD, M. B., Norvell, PhD, D. C., Dettori, PhD, J. R., Fehlings, MD, PhD, FRCSC, FACS, M.G., & Chapman, MD, J. R. (2010). Surgeon Perceptions and Reported Complications in Spine Surgery. Spine, 35(9S).  Retrieved August 31, 2011, from http://www.medscape.com/viewarticle/721611

Staff, M. C. (n.d.). Chiropractic adjustment: Risks – MayoClinic.com. Mayo Clinic. Retrieved August 31, 2011, from http://www.mayoclinic.com/health/chiropractic-adjustment/MY01107/DSECTION=risks

Stevinson, MS, C., & Ernst, MD, PhD, E. (2002). Risks Associated With Spinal Manipulation. The American Journal of Medicine, 112(7), 566-571. Retrieved August 31, 2011, from http://www.sciencedirect.com/science/article/pii/S0002934302010689

Dr. Tripp Stover, D.C.

Dr. Stover grew up in Richmond. He has been married to his wife Andrea since 2000 and they make their home in Mechanicsville with their children, Avery and Garnett.

Dr. Tripp Stover, D.C.

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