National Board of Chiropractic Examiners (NBCE) Practice Test

Which of these is an absolute contraindication to spinal manipulation?

1. Cauda equina insult

2. Osteoporosis

3. Recent fracture

4. Severe muscle strain

The correct answer is: Cauda equina insult

An absolute contraindication to spinal manipulation is a condition where performing the manipulation would pose significant risk to the patient, potentially leading to serious harm. Cauda equina syndrome is characterized by severe compression of the cauda equina, which is a bundle of spinal nerves extending from the lower end of the spinal cord. This condition may result from various factors, such as a herniated disc, tumor, or trauma, leading to symptoms such as lower back pain, leg weakness, numbness, and bowel or bladder dysfunction. Performing spinal manipulation in the presence of cauda equina syndrome could worsen the nerve compression, resulting in irreversible damage. Therefore, when this condition is suspected, the intervention must be evaluated with extreme caution, and often surgical intervention is required rather than chiropractic manipulation. In contrast, while osteoporosis, recent fractures, and severe muscle strains may present complications or require modifications in care, they do not pose the same level of risk associated with cauda equina syndrome. Patients with these conditions may still be treated with manipulation under certain circumstances, provided that the chiropractor employs appropriate techniques and assessments.