Faculty of Health Sciences, Ontario Tech University and Centre for Disability Prevention and Rehabilitation, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada.
Canadian Memorial Chiropractic College, North York, Ontario, Canada.
Chiropr Man Therap. 2020 Jul 9;28(1):33. doi: 10.1186/s12998-020-00323-8.
When indicated by signs or symptoms of potentially serious underlying pathology (red flags), chiropractors can use radiographs to inform their diagnosis. In the absence of red flags, the clinical utility of routine or repeat radiographs to assess the structure and function of the spine is controversial.
To determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. Investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. The research objectives required that we determine the validity, diagnostic accuracy and reliability of radiographs for the structural and functional evaluation of the spine.
We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from inception to November 25, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (cross-sectional, case-control, cohort, randomized controlled trials, diagnostic and reliability) were critically appraised. Studies of acceptable quality were included in our synthesis. The lead author extracted data and a second reviewer independently validated the data extraction. We conducted a qualitative synthesis of the evidence.
We identified 959 citations, screened 176 full text articles and critically appraised 23. No relevant studies assessed the clinical utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. No studies investigated whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. Nine low risk of bias studies investigated the validity (n = 2) and reliability (n = 8) of routine or repeat radiographs. These studies provide no evidence of clinical utility.
We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.
当存在潜在严重基础病理的迹象或症状（危险信号）时，脊医可以使用 X 光片来协助诊断。在没有危险信号的情况下，常规或重复拍摄 X 光片来评估脊柱的结构和功能的临床实用性存在争议。
确定在没有危险信号的情况下，常规或重复拍摄颈椎、胸椎或腰椎 X 光片（颈椎、胸椎或腰椎）对脊柱功能或结构评估的诊断和治疗效用。调查重复 X 光片上的功能或结构发现是否是有临床意义的结果的有效标志物。研究目标要求我们确定 X 光片在评估脊柱结构和功能方面的有效性、诊断准确性和可靠性。
我们从建库开始到 2019 年 11 月 25 日检索了 MEDLINE、CINAHL 和脊骨神经医学文献索引。我们使用了世界卫生组织推荐的快速审查方法。纳入了合格的研究（横断面研究、病例对照研究、队列研究、随机对照试验、诊断和可靠性研究）并对其进行了严格的评估。纳入了质量可接受的研究进行综合分析。第一作者提取数据，第二作者独立验证数据提取。我们对证据进行了定性综合。
我们确定了 959 条引用，筛选了 176 篇全文文章，并对 23 篇文章进行了严格评估。没有研究评估常规或重复拍摄颈椎、胸椎或腰椎 X 光片（颈椎、胸椎或腰椎）对脊柱功能或结构评估的临床实用性。没有研究调查重复 X 光片上的功能或结构发现是否是有临床意义的结果的有效标志物。9 项低偏倚风险的研究调查了常规或重复 X 光片的有效性（n=2）和可靠性（n=8）。这些研究没有提供任何临床实用性的证据。
我们没有发现使用常规或重复 X 光片评估脊柱功能或结构，在没有危险信号的情况下，会改善临床结果并使患者受益的证据。鉴于电离辐射的固有风险，我们建议脊医不要常规和重复使用 X 光片来评估脊柱的结构和功能。
