No increased risk of spinal cerebrospinal fluid leak after spinal manipulative therapy: A retrospective cohort study.

The study only included patients with spinal disorders and excluded those with serious spinal pathology, so the results do not apply to those groups. The follow-up period was short, limited to two months, which may miss delayed presentations. The data did not allow verification of the specific type or location of the cerebrospinal fluid leak via imaging. The study could not determine if specific manipulative techniques or doses were associated with risk. Selection bias remains possible, as patients seeking physical therapy may have different baseline health profiles than those seeking chiropractic care, despite matching.

The study was supported by the Clinical and Translational Science Collaborative of Northern Ohio, funded by the National Institutes of Health. Robert J. Trager received royalties from two texts on sciatica. The funders did not play a role in the study protocol or decision-making.

Do not assume this study proves spinal manipulative therapy is risk-free for all patients. It specifically excludes those with serious spinal pathology like infection, malignancy, or fracture, where manipulative therapy is contraindicated. Additionally, the similar leak rates in both groups suggest that the leaks were likely present before the treatment started, causing the symptoms that led the patient to seek care.