Stuber Kent Jason, Wynd Shari, Weis Carol Ann
Division of Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1, Canada.
Chiropr Man Therap. 2012 Mar 28;20:8. doi: 10.1186/2045-709X-20-8.
The safety of spinal manipulation during pregnancy and the postpartum periods has been a matter of debate among manual therapists. Spinal manipulative therapy during these periods is a commonly performed intervention as musculoskeletal pain is common in these patients. To date there has not been an evaluation of the literature on this topic exclusively.
A literature search was conducted on PubMed, CINAHL and the Index to Chiropractic Literature along with reference searching for articles published in English and French in the peer-reviewed literature that documented adverse effects of spinal manipulation during either pregnancy or postpartum. Case reports, case series, and any other clinical study designs were deemed acceptable for inclusion, as were systematic reviews. The appropriate Scottish Intercollegiate Guidelines Network (SIGN) tools were used to rate included articles for quality when applicable.
Five articles identifying adverse events in seven subjects following spinal manipulation were included in this review, along with two systematic reviews. The articles were published between 1978 and 2009. Two articles describing adverse effects from spinal manipulation on two postpartum patients were included, while the remaining three articles on five patients with adverse effects following spinal manipulation were on pregnant patients. Injury severity ranged from minor injury such as increasing pain after treatment that resolved within a few days to more severe injuries including fracture, stroke, and epidural hematoma. SIGN scores of the prospective observational cohort study and systematic reviews indicated acceptable quality.
There are only a few reported cases of adverse events following spinal manipulation during pregnancy and the postpartum period identified in the literature. While improved reporting of such events is required in the future, it may be that such injuries are relatively rare.
孕期和产后进行脊柱推拿的安全性一直是手法治疗师们争论的话题。在这些时期进行脊柱推拿治疗是一种常见的干预措施，因为这些患者中肌肉骨骼疼痛很常见。迄今为止，尚未专门对该主题的文献进行评估。
在PubMed、CINAHL和脊椎按摩文献索引中进行文献检索，并通过参考文献搜索同行评审文献中以英文和法文发表的记录孕期或产后脊柱推拿不良反应的文章。病例报告、病例系列以及任何其他临床研究设计均被视为可纳入，系统评价也同样如此。在适用时，使用适当的苏格兰跨学院指南网络（SIGN）工具对纳入的文章进行质量评分。
本综述纳入了5篇确定脊柱推拿后7名受试者出现不良事件的文章，以及2篇系统评价。这些文章发表于1978年至2009年之间。其中包括2篇描述脊柱推拿对2名产后患者产生不良反应的文章，其余3篇关于5名脊柱推拿后出现不良反应患者的文章是关于孕妇的。损伤严重程度从轻微损伤（如治疗后疼痛加剧，几天后缓解）到更严重的损伤（包括骨折、中风和硬膜外血肿）不等。前瞻性观察队列研究和系统评价的SIGN评分表明质量可接受。
文献中仅报道了少数孕期和产后脊柱推拿后出现不良事件的病例。虽然未来需要改进对此类事件的报告，但此类损伤可能相对罕见。
