1. The author of the letter is concerned that the title of the article is somewhat misleading. We do concur with this, and would note that the original title of this case report that we submitted to the journal was “Unstable Thoracic Spine Fracture and Massive Hemothorax After Chiropractic Manipulation Under Anesthesia.” The journal itself requested that we change it to fit the format of their case reports.
2. We would respectfully disagree that manipulation under anesthesia (MUA) is a “mainstream medical procedure.”As allopathic clinicians, we acknowledge our error and failure to differentiate between osteopathic physicians and chiropractic care in the discussion. We certainly have no agenda with this communication. The patient mentioned in the case report specifically asked that we not make any negative remarks about his chiropractor and chiropractic care in general, as he had a good relationship with his chiropractor. We also had no reason to defame the individual chiropractor or chiropractic care in general.
3. The specific case in our report involves manipulation under anesthesia, but the same type of complication could happen with any procedure under sedation, performed by any type of clinician. As is stated in the letter, “For this particular patient, it is likely that this patient was not, nor should have been, a candidate for MUA in the first place, as evidenced by published indications and contraindications.” We agree.
4. We do not think that the single paragraph we devoted to general chiropractic manipulation renders our entire discussion section irrelevant. The bulk of our discussion does center on MUA, and we stand by our review of the literature on this subject. Details were abbreviated and discussion limited due to the nature of a case report.
5. As this is a case report, there is really no “study design” to speak of.The hemothorax and spine fracture were temporally associated with MUA. The symptoms began immediately after introduction of the procedure, and there were no other events that had any relation to the symptoms and eventual findings. There was no other obvious cause.
Again, we thank the author of this letter for taking the time to comment on our report, and we appreciate being given the opportunity to respond.
Scott C. Gardner, PA-C, MMSc, DFAAPA, Sarah D. Majercik, MD, MBA, FACS, Don VanBoerum, MD, FACS, John R. Macfarlane, MD
References
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8. Tain L, Gunderson C, Cremata E, et al; Committee for Manipulation Under Anesthesia. Recommendations to the Industrial Medical Council Work Group of California for manipulation under anesthesia use for injured workers. Sacramento: Industrial Medical Council; 2003.