Les manipulations cervicales (MC) sont responsables d'accidents graves d'ordre neurologique. Ils sont rarissimes et le plus souvent imprévisibles. Pour répondre aux principes de prévention et de précaution, il nous paraît judicieux de diminuer le nombre de MC pratiquées. Cinq recommandations consensuelles peuvent être édictées : recherche d'accidents même minimes lors d'une manipulation précédente qui contre-indiqueraient toute nouvelle manipulation ; examen clinique préalable, en particulier neurologique ; respect des contre-indications et indications reconnues ; exigence d'une compétence affirmée du médecin manipulateur ; prudence quant aux manipulations cervicales de première intention.

Cervical spine manipulation and the precautionary principle. Cervical manipulations can cause severe neurological complications, which are both exceedingly rare and generally unpredictable. To meet the requirements of the principles of prevention and precaution, we believe the number of cervical manipulations should be reduced. To this end, we suggest that five recommendations developed by consensus be followed: unwanted effects, however minor, of previous manipulation should be looked for routinely and taken as absolute contraindications to further manipulation; a thorough physical examination, including a neurological evaluation, should be performed prior to manipulation; all known contraindications and indications should be followed; manipulation should be performed only by physicians experienced in this technique; and special caution should be exercised when performing first-line cervical manipulation.