ArticlePM & R : the journal of injury, function, and rehabilitation2026
Chiropractic spinal manipulative therapy versus physical therapist-led exercise and the risk of cauda equina syndrome in adults with lumbar disc herniation, stenosis, or radiculopathy.
Article in PM & R : the journal of injury, function, and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- Reply to letter Re: Chiropractic spinal manipulative therapy versus physical therapist-led exercise and the risk of cauda equina syndrome in adults with lumbar disc herniation, stenosis, or radiculopathy.PM & R : the journal of injury, function, and rehabilitation · 2026Article
- Letter re: Chiropractic spinal manipulative therapy versus physical therapist-led exercise and the risk of cauda equine syndrome in adults with lumbar disc herniation, stenosis, or radiculopathy.PM & R : the journal of injury, function, and rehabilitation · 2026Article
- Clinical management of a Veteran with chronic scan-negative cauda equina syndrome: a case report.The Journal of the Canadian Chiropractic Association · 2026Article
- Chiropractic spinal manipulative therapy versus physical therapist-led exercise and the risk of cauda equina syndrome in adults with lumbar disc herniation, stenosis, or radiculopathy.PM & R : the journal of injury, function, and rehabilitation · 2026Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundCauda equina syndrome is a surgical emergency often caused by lumbar disc herniation. Spinal manipulative therapy is commonly used for lumbar spine disorders, but case reports have raised concerns it may precipitate cauda equina syndrome. One cohort study suggested no increased risk, although it did not focus on patients with lumbar spine disorders pertinent to cauda equina syndrome, such as disc herniation, stenosis, or radiculopathy/sciatica.
objectiveTo address this evidence gap, we tested the null hypothesis that there is no increased risk of cauda equina syndrome following spinal manipulative therapy among adults with these lumbar spine disorders compared to matched controls receiving physical therapist-led therapeutic exercise (PTE).
methodsUsing a retrospective cohort design, we queried a U.S. research network (TriNetX) including patients aged ≥18 years with a lumbar spine disorder and excluding those with preexisting cauda equina syndrome, incontinence, serious spinal pathology, and recent spine surgery/injection. Data spanned 2005-2025. Patients were divided into cohorts: (1) spinal manipulative therapy administered by a chiropractor or (2) PTE without spinal manipulative therapy. Propensity score matching controlled for confounding variables. Outcomes included the risk ratio of cauda equina syndrome (primary), and bladder catheterization and bowel incontinence as additional cauda equina syndrome markers (secondary).
resultsAfter matching, there were 34,376 patients in each cohort. Comparing the spinal manipulative therapy cohort to PTE cohort, the incidence and risk of cauda equina syndrome did not significantly differ (risk ratio=0.88 [95% CI, 0.43-1.79]; p = .715). The risk of bladder catheterization (risk ratio = 0.50 [95% CI, 0.39- 0.64]; p < .001) and fecal incontinence (risk ratio = 0.50 [0.37, 0.68]; p < .001) was significantly lower in the spinal manipulative therapy cohort.
conclusionAmong adults with lumbar disc herniation, stenosis, and/or radiculopathy, we did not identify an association between spinal manipulative therapy and an increased risk of cauda equina syndrome.
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