Can You Use Spinal Manipulation (SMT) on Post-Surgical Spine Patients? A New Study Weighs In

Can chiropractors safely use spinal manipulation on patients who’ve had spinal surgery? A new descriptive study helps answer one of the most common clinical questions we face — and the findings are more reassuring than you might expect.

Spine-related disorders remain highly prevalent, and surgical management for cervical and lumbar conditions has increased steadily over time. Many patients with persistent or recurrent symptoms after surgery either don’t pursue further surgery or are managed non-surgically — and a meaningful number end up in chiropractic offices. The question of whether spinal manipulative therapy (SMT) is appropriate in this population comes up regularly in practice, yet the literature describing safety outcomes in these patients has been limited.

What This Study Set Out to Answer

Researchers conducted a descriptive chart review of adults who received SMT following prior spinal surgery. The study focused on three things: who received SMT after surgery, what that care looked like, and whether any serious short-term adverse events were identified following treatment.

This was not a randomized trial testing effectiveness — it was a safety-oriented descriptive study, and that distinction matters for how you interpret the findings.

Key Findings

• No serious short-term adverse events were identified in the cohort following SMT
• Most patients received SMT approximately one year post-surgery — not in the immediate postoperative window
• The cohort reflected a range of cervical and lumbar surgical histories, managed across academic clinical settings

These are descriptive findings from a chart review, not a controlled trial — but the absence of major short-term complications in a reasonably sized academic cohort is clinically meaningful, particularly given how often safety is the first question raised in these cases.

What This Means in Clinical Practice

Prior spine surgery should not automatically be treated as an absolute contraindication to SMT — but it should consistently prompt careful clinical reasoning, thorough documentation, and a case-by-case approach.

The risk of overly rigid thinking cuts both ways here. Some clinicians assume a surgical history makes SMT categorically unsafe. Others may become too comfortable too quickly. The evidence supports a middle path: serious short-term complications were not observed in this sample, which is reassuring — but it is not a guarantee of safety in every patient or every clinical scenario.

From a practical standpoint, postsurgical spine patients deserve thoughtful assessment, not routine assumptions in either direction.

📋 Clinical Takeaway
Prior spine surgery ≠ automatic SMT contraindication. This descriptive study found no serious short-term adverse events following SMT in adults with a history of spinal surgery (most treated ~1 year post-op). Treat these cases with careful clinical reasoning and sound documentation — neither reflexive avoidance nor uncritical routine.

This Week’s Research Review

“Adverse Events Following SMT After Spine Surgery” — published in the Journal of Manual and Manipulative Therapy (2025)

📄 Get the full review — including detailed patient demographics, care characteristics, and complete clinical application commentary — for just a couple of dollars: [Access the review here]

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About the Author

Dr. Shawn Thistle, DC – 20+ years in clinical practice, founder of RRS Education and www.shawnthistle.com, research review and knowledge transfer specialist.