Vautravers Ph, Maigne J-Y
Service de Médecine Physique et de Réadaptation, Hôpital de Hautepierre, Strasbourg.
Rev Neurol (Paris). 2003 Nov;159(11):1064-6.
Cervical manipulation is a widely used method indicated in non-specific mechanical neck pain and cervicogenic headache. Cervical manipulation can cause severe neurologic complications which are both rare and generally unpredictable, which can be compared with the accidents occurring with other treatments (nonsteroidal anti-inflammatory drugs...). To decrease this risk, we propose five recommendations developed by consensus: --unwanted effects, however minor (e.g. nausea or vertigo), of prior manipulation should be searched for routinely and taken as contraindications for future spinal manipulations; --a thorough physical examination, including a neurological evaluation should be performed prior to manipulation; --all know indications and contraindications should be followed; -- manipulations should be performed only by physicians experienced in this technique; --special caution should be exercised when performing first-line cervical manipulation and simple, honest and easily understandable information about these risks should be included when informed consent is obtained.
颈椎推拿是一种广泛应用于非特异性机械性颈部疼痛和颈源性头痛的方法。颈椎推拿可能会导致严重的神经并发症，这些并发症既罕见又通常不可预测，这与其他治疗方法（非甾体类抗炎药……）所发生的意外情况类似。为降低这种风险，我们提出了通过共识制定的五条建议：——应常规检查先前推拿产生的不良影响，无论多么轻微（如恶心或眩晕），并将其作为未来脊柱推拿的禁忌证；——在推拿前应进行全面的体格检查，包括神经学评估；——应遵循所有已知的适应证和禁忌证；——推拿应由精通此技术的医生进行；——在进行一线颈椎推拿时应格外小心，在获得知情同意时应包含关于这些风险的简单、诚实且易于理解的信息。
