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Chiropr Man Therap. 2018 Nov 21;26:48. doi: 10.1186/s12998-018-0217-8. eCollection 2018.

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

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1Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia.
2Faculty of Health, University of Technology Sydney, Sydney, Australia.
3School of Rehabilitation Therapy, Queen's University, Kingston, ON Canada.


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.


Appropriate use of imaging; Back pain; Chiropractic; Clinical guidelines; Imaging indications; Low back pain; Neck pain; Spinal X-rays

Conflict of interest statement

Not applicableNot applicableSDF is Deputy Editor-in-Chief of Chiropractic and Manual Therapies. He played no part in the assignment of this manuscript to Associate Editors or peer reviewers, and was blinded in the online editorial system for this manuscript from submission to final decision. Otherwise, the authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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