Leung Bryden, Treleaven Julia, Dinsdale Alana, Marsh Linda, Thomas Lucy
School of Health and Rehabilitation Sciences, University of Queensland, Australia.
School of Health and Rehabilitation Sciences, University of Queensland, Australia.
J Bodyw Mov Ther. 2025 Mar;41:56-77. doi: 10.1016/j.jbmt.2024.10.018. Epub 2024 Oct 30.
Previous reviews on serious adverse events (SAEs) following physical interventions involving the neck have focused on vascular SAEs or those related to cervical manipulation.
To review the evidence for all serious adverse events associated with any physical cervical procedures and describe SAE characteristics.
Searches were conducted in PubMed, EMBASE, CINAHL, Scopus, Cochrane, Web of Science and Index to Chiropractic Literature from inception to May 2023 for studies reporting characteristics of SAE following any neck intervention and patient demographics.
Two hundred and thirty-three studies describing 334 SAE cases were identified. Forty-one were reported in the last 5 years. The results confirmed findings of past reviews with most events being vascular (58%) and mainly arterial dissection or vertebral artery related and the majority involving manipulation (75%). However lesser-known SAES ie neurological (25%), combined vascular/neurological (12%) and others (5%) which included cases such as cerebrospinal fluid leaks, phrenic nerve palsies and retinal detachments were identified. Further, some followed procedures such as vestibular testing, gentle mobilization, exercises, acupuncture or even massage. Initial symptoms included sharp increases in headache/neck pain, nausea, vomiting, dizziness and altered sensation, during treatment or within 48 h, often preceding neurological signs. Most recovered favourably (62%), 16% with disability, 6% died, the rest were unspecified.
Most SAEs were vascular and associated with manipulation but awareness of potential neurological and orthopaedic injuries and other procedures should be raised. Monitoring for early signs of SAEs for up to 48 h post-intervention is advisable if a SAE is suspected.
以往关于涉及颈部的物理干预后严重不良事件（SAE）的综述主要集中在血管性SAE或与颈椎手法治疗相关的SAE上。
回顾与任何颈部物理治疗相关的所有严重不良事件的证据，并描述SAE的特征。
在PubMed、EMBASE、CINAHL、Scopus、Cochrane、Web of Science和脊椎按摩文献索引中进行检索，检索时间从数据库建立至2023年5月，以查找报告任何颈部干预后SAE特征及患者人口统计学信息的研究。
共识别出233项描述334例SAE病例的研究。其中41项是过去5年报道的。结果证实了以往综述的发现，大多数事件为血管性（58%），主要是动脉夹层或与椎动脉相关，且大多数涉及手法治疗（75%）。然而，也发现了一些较少见的SAE，即神经学方面的（25%）、血管/神经联合的（12%）和其他方面的（5%），其他方面包括脑脊液漏、膈神经麻痹和视网膜脱离等病例。此外，一些SAE发生在诸如前庭测试、轻柔松动、锻炼、针灸甚至按摩等治疗之后。初始症状包括在治疗期间或48小时内头痛/颈部疼痛急剧加重、恶心、呕吐、头晕和感觉改变，这些症状通常先于神经学体征出现。大多数患者恢复良好（62%），16%有残疾，6%死亡，其余情况未明确说明。
大多数SAE是血管性的且与手法治疗相关，但应提高对潜在神经和骨科损伤以及其他治疗的认识。如果怀疑发生SAE，建议在干预后长达48小时内监测SAE的早期迹象。
