Current evidence for spinal X-ray use in the chiropractic profession: a narrative review

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Abstract

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.
Original languageEnglish
Article number48
Pages (from-to)1-11
Number of pages11
JournalChiropractic and Manual Therapies
Volume26
Issue number1
DOIs
Publication statusPublished - 21 Nov 2018

Bibliographical note

Copyright the Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • chiropractic
  • spinal X-rays
  • clinical guidelines
  • appropriate use of imaging
  • low back pain
  • back pain
  • neck pain
  • imaging indications
  • Back pain
  • Imaging indications
  • Chiropractic
  • Low back pain
  • Spinal X-rays
  • Neck pain
  • Clinical guidelines
  • Appropriate use of imaging

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