Response to the Letter to the Editor

Article Outline

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In Response:

We would like to thank the writer for his insightful comments. We would like to address the pertinent remarks in this letter. Firstly, it was never our purpose to provide sound evidence that chiropractors need their own set of radiography guidelines. We hope that through analysis of this type of data, we can supply some evidence for the myriad of controversial questions surrounding the issue. We suggest that some constructive dialogue in this area is long overdue and that if we fail to establish our own guidelines, should this be appropriate, other agencies will do it, possibly without our input.

The full spine radiographs that were used in this study were taken in accordance with the Standards of Practice Guidelines clause 4.3.1 of the New Zealand Chiropractic Board. It is our understanding that these standards are currently under review.

We agree with the author and state in our discussion that some of the anomalies that were included may not alter the adjustive strategies or procedures that chiropractors may decide to use. However, there is enough disagreement in the literature (as referenced in our article) over the clinical relevance of the occurrence of these anomalies to warrant some investigation into the clinical utility of full spine x-rays before we arrive at the conclusion that they are unjustified. In other words, there is no evidence that we are aware of that concludes that altering patient management in the presence of the anomalies that we reported on does not result in improved patient outcomes.

We welcome the discussion that this topic will hopefully generate and have reported these findings in an attempt to generate more dialogue and investigation in this very important area.