It is good to start the discussion on the safety of spinal adjustments by chiropractors against the use of surgical procedures by medical doctors in the treatment of musculoskeletal problems by comparing the knowledge and competency level of the practitioners of the disciplines of chiropractic and conventional medicine on musculoskeletal disorders. After all, it is these disorders that they both try to address, and the treatment methods for which we are comparing the safety aspects of.
From 1998 to 2002, Kevin B, Freedman, M.D. published a series of reports that highlighted the lack of training in musculoskeletal conditions among resident doctors. The heads of departments of several hospital orthopedic programs designed a standard exam on musculoskeletal competency for their residents. 82% of the medical school graduates who took the examination failed. Four years later, a simplified version of the test was given and this time, 78% of the medical examinees failed to prove basic competency in the area of musculoskeletal medicine. The same test when given to senior students of chiropractic, however, resulted in a 70% passing rate for these students. The results showed quite a glaring difference between competencies of medicine graduates and senior students of chiropractic.
The medical graduates have completed years of residency. Furthermore, they had been admitted into a competitive residency program in orthopedic, supposedly the highest point in medical musculoskeletal specialist practice.
The Risks of Spinal Surgery
Here’s some historical background on medical surgery. In 1974, the findings from the hearings conducted by the Congressional Committee on Interstate and Foreign Commerce on unnecessary surgery found that 17.6% of surgical recommendation from the First Surgical Second Opinion Program was not confirmed. These figures were extrapolated by the House Subcommittee on Oversight and Investigations and came up with an estimate that on a national level and annual basis, there were a total of 2.4 million surgeries considered as unnecessary. This will have resulted in 11,900 deaths and cost $3.8 billion annually.
The total number of lower back surgeries in the U.S. in 1995 was estimated to exceed 250,000 and the hospital cost at $11,000 per patient. These figures indicate that the total unnecessary back surgeries in the U.S. that year will total 44,000 and cost as high as $484 million.
From this, we know that spinal surgery, for maybe not being necessary is in itself, one of the biggest risks.
In other more recent studies, it is known that the failure rate of back surgery is 74%! The Journal of the American Academy of Orthopedic Surgeons analyzed that the reasons for failed back surgery can be incorrect diagnosis, poor patient selection, suboptimal surgery selection, failure to achieve goals in surgery, poor technique and recurrent pathology.
Safety of Chiropractic Spinal Adjustments
Now let’s take a look at the safety record of chiropractic adjustments.
Malpractice insurance carriers are keenest in examining injury statistics. The malpractice claim records against chiropractic for the period 1988 to 1997 were reviewed by Scott Haldeman, MD, DC. In the review, it was found that there a total of 23 reported cases of vertebral artery dissection or stroke. Of these, 10 cases involved complicating factors like high blood pressure, history of smoking, and use of contraceptives, all of which have links with vascular disease. The actual stroke or vertebral artery dissection incidence came out out to be one for every 5.85 million adjustments! Although there are other reports purportedly showing higher frequency of chiropractic adverse events, they have negative bias in that those authors inappropriately used chiropractor as the practitioner who performed the manipulations even when the a medical doctor, physical therapist or non-healthcare service professional was responsible for the injury.
Failed back surgeries are becoming a common problem. They result to enormous costs to all the stakeholders – patients, insurers and government. The risks they present is great and the its success rate is uncertain, at best.
On the other hand, studies made by research institutions, the medical community and governments, such as in the case of Canada, conclude that chiropractic treatment is safe, brings no complications, cost-efficient and most importantly, effective in the management of low back pain and musculoskeletal problems.