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Chiropractic Journal of Australia : CJA March 2013
8 Chiropractic Journal of Australia Volume 43 Number 1 March 2013 • Another answer could be the adoption of a second term into the ICD - that being the Vertebral Subluxation Syndrome (VSS), a term advocated by Gatterman in 199275 • The concept was endorsed by Fuhr in 2002.76 There is also Jackson's text The Cervical Syndrome as a precedent.77 The VSC could cover the pathophysiological or biological fnding, and the VSS to represent the clinical presentation, the subluxation-related condition. • The expression Articular Subluxation Complex (ASC), should be also be required as a means of covering non- spinal articulation disturbance and to differentiate it from a sprain. • It is also essential that the WHO amend its terminology and adopt the generally accepted terminology. • It would also then be essential for the VSC, VSS and the ASC to be included in the MeSH or Key Words listings for journals. SUMMARY This commentary has attempted to demonstrate: - that there is widespread recognition of the multifaceted subluxation -- the VSC - that it has been recognised in medicine - that there is a sound scientifc basis for its recognition - that there is suffcient evidence of the subluxation to justify its use - that there is strong emerging research supporting this subluxation hypothesis - that its recognition goes back over 100 years - that subluxation of vertebrae is a recognised and accepted term -- albeit as a VSC - that the term subluxation is used in the chiropractic and medical literature and textbooks - that evidence in support of the VSC hypothesis is a comparative situation to evidence supporting other accepted theories in other health professions, including medicine. - that medicine, chiropractic, osteopathy and other healing sciences are all based on theories. Some may advocate that any confusion is produced by the use of the single term subluxation that has lead to this dilemma, when it already has other meanings. That is a solvable situation. Given the weight of evidence and common sense, the truly scientifc approach would be for cynics to acknowledge that there is suffcient reason to justify its continued use, and to call for further research78 to investigate why VSC's seem to have the effects and benefts they do; and that addressing them seems to resolve many symptoms and signs as suggested by Wenban and Vernon. Research has yet to be produced which disproves the existence and signifcance of the VSC.78,79 Those who are critical of the chiropractic hypotheses must therefore also be critical of those of their medical manipulation colleagues who not only support, practise, publish, and collaborate it, but in some cases even attend chiropractors as patients. CONCLUSION There does appear to be some justifcation to the advisability of the continued use of the solitary term subluxation. Some alternatives appear to be somewhat too broad, other have more than a solitary meaning. Given the recent usage, perhaps the best compromise for this clinical entity is the Vertebral Subluxation Complex (VSC). The term 'subluxation' used in the chiropractic sense has far to many metaphors in the literature to be ignored as a clinical entity. It has been in use medically as well as 'chiropractically' for far too long and accepted far too widely to be dismissed. The explanatory adjuncts Vertebral and Complex to comprise the Vertebral Subluxation Complex, could satisfy most contrary views and differentiate it from an uncomplicated minor dislocation or sprain in the medical sense There would also have to be a case for dual terms to be adopted -- the VSC as well as the Vertebral Subluxation Syndrome (VSS).80 The former would describe the patho- anatomical fndings, while the latter would incorporate the clinical signs and symptoms -- the pathophysiology. It is submitted that the terms, particularly in relation to the spine, Vertebral Subluxation Complex (VSC) and Vertebral Subluxation Syndrome (VSS) would be adequate to cover the various clinical presentations associated with it. It is further submitted that there is ample evidence even at this stage, for the existence of an identifiable pathoneurophysiological intra-articular clinical fnding that is only now receiving broader recognition, and for it to be more clearly designated. It is now a matter of just modifying the WHO classifcation, as well as incorporating the terms in the ICD and MeSH classifcations. Given the evidence available, it would behove critics to now outline precisely what they have against the use of the term subluxation, particularly in its revised form of a VSC or indeed a VSS. If, as some claim, there is no proof that it exists, they should then be required to describe and defne what it is that they are manipulating. One could hardly fnd signs and symptoms to justify manipulating a normal functioning spine. A somatic dysfunction or other term in use would also need proof of existence to satisfy these same critics and justify intervention. Indeed manipulating non symptomatic patients inhibits refexes.81 Perhaps detractors would be happy with a term like 'Pathophysiological Neuromechanical Articular Complex' (PNAC), however the controversy begins all over again! Given the strength of evidence and the inter-professional recognition of the VSC as outlined, further research programs on the hypothesis are welcome and current research is most encouraging. COMMENTARY ROME
CJA December 2012
CJA June 2013