Jenkins Hazel J, Downie Aron S, Moore Craig S, French Simon D
1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.
2Faculty of Health, University of Technology Sydney, Sydney, Australia.
Chiropr Man Therap. 2018 Nov 21;26:48. doi: 10.1186/s12998-018-0217-8. eCollection 2018.
The use of routine spinal X-rays within chiropractic has a contentious history. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of 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 use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.
脊椎按摩疗法中常规脊柱X光检查的使用有着充满争议的历史。该行业的一些人主张需要进行常规脊柱X光检查以改善患者管理，而其他脊椎按摩师则主张仅在当前影像学指南认可时才使用脊柱X光检查。本综述旨在总结脊椎按摩疗法中使用脊柱X光检查的现有证据，并考虑相关风险和益处。现有证据支持仅在诊断创伤和脊椎关节病以及评估青少年特发性脊柱侧弯等进行性脊柱结构畸形时使用脊柱X光检查。MRI适用于诊断癌症或感染等严重病变，并评估神经根病和椎管狭窄的手术治疗需求。有力证据表明成像存在风险，如过度辐射暴露、过度诊断、随后的低价值检查和治疗程序以及成本增加。在大多数情况下，包括脊柱X光检查在内的常规成像的潜在益处并不超过潜在危害。脊柱X光检查不应在脊椎按摩疗法中常规进行，而应遵循临床指南和临床医生的判断。
