In 2010, 204 of every 1000 new patients presenting to a chiropractor in the United States received radiographs within 5 days of initial presentation, and the rate of spinal radiography by chiropractors and podiatrists increased by 14.4% between 2003 and 2015. There are a lot of chiropractors taking a lot of spinal x-rays! But, should they be doing this?
Current guidelines suggest the use of radiographs in the presence of signs and symptoms of potentially serious underlying pathology (commonly referred to as ‘red flags’). However, factions of chiropractors endorse the use of routine or repeat radiographs to assess spinal structures and function. In fact, this practice forms the basis for approximately 23 chiropractic technique systems (ex. Gonstead, Chiropractic Biophysics, NUCCA and others), which would (hopefully?) suggest that routine and repeat radiographs are supported by scientific evidence. Proponents of these techniques have published their own guidelines to assist clinicians with the biomechanical assessment of spinal subluxation through radiography. These claims have not been evaluated for their clinical utility, nor the benefit a patient may glean from a given test or the resultant treatment.
The authors of this study conducted an independent, rapid review of the literature to investigate the clinical utility (including diagnostic utility and therapeutic utility) of routine and repeat radiographs (without red flags) for the structural and functional assessment of the spine by chiropractors. As well, they investigated whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful change. This required them to first determine the validity and reliability of radiographs for functional and structural assessment of the spine...LOG IN OR SUBSCRIBE TO ACCESS THIS REVIEW
THIS WEEK'S RESEARCH REVIEW: “Clinical Utility of Routine Spinal Radiographs by Chiropractors”
This paper was published in Chiropractic and Manual Therapies (2020) and this Review is posted in Recent Reviews, Clinical Practice, Imaging and the 2020 Archive.
Chiropractic spinal imaging