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However, the nature of the potential association between\n SMT<\/jats:styled-content>\n and\n CSF<\/jats:styled-content>\n leak is uncertain, and symptoms such as neck pain or headache may reflect preexisting leaks rather than effects of\n SMT<\/jats:styled-content>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To test the hypothesis of no significant association between\n SMT<\/jats:styled-content>\n and spinal\n CSF<\/jats:styled-content>\n leak, comparing chiropractic\n SMT<\/jats:styled-content>\n recipients to matched controls undergoing physical therapist\u2010supervised therapeutic exercises (\n PTE<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We searched a health\u2010records\u2010based U.S. dataset (\n TriNetX<\/jats:styled-content>\n ,\n LLC<\/jats:styled-content>\n ) for adults with spinal disorders receiving an index event of (1)\n SMT<\/jats:styled-content>\n or (2)\n PTE<\/jats:styled-content>\n without\n SMT<\/jats:styled-content>\n from 2005 to 2024, excluding those with preexisting\n CSF<\/jats:styled-content>\n leaks and related conditions, using propensity matching to minimize confounding. Our primary outcome was the risk ratio (\n RR<\/jats:styled-content>\n ) of spinal\n CSF<\/jats:styled-content>\n leak occurring within 2\u2010month follow\u2010up. A secondary composite outcome included the diagnosis of spontaneous intracranial hypotension in addition to the primary outcome.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n After matching, 89,042 patients remained per cohort. There was no significant association between\n SMT<\/jats:styled-content>\n and spinal\n CSF<\/jats:styled-content>\n leak incidence or risk compared to\n PTE<\/jats:styled-content>\n (both cohorts: 0.03% [95%\n confidence interval<\/jats:styled-content>\n : 0.02%\u20130.04%];\n RR<\/jats:styled-content>\n \u2009=\u20090.85 [0.49\u20131.49];\n p<\/jats:italic>\n \u2009=\u2009.572). Adding spontaneous intracranial hypotension to the primary outcome yielded similar results.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The present findings suggest chiropractor\u2010administered\n SMT<\/jats:styled-content>\n does not increase the risk of spinal\n CSF<\/jats:styled-content>\n leak in adults with spinal disorders relative to\n PTE<\/jats:styled-content>\n . Although our analysis focused on chiropractor\u2010delivered\n SMT<\/jats:styled-content>\n , the findings could plausibly apply to\n SMT<\/jats:styled-content>\n delivered by other clinician types, warranting further research. Given the overlapping symptoms of\n CSF<\/jats:styled-content>\n leak and musculoskeletal neck pain or headache, clinicians who manage spinal disorders should be aware of this condition.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/pmrj.70072","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T10:05:22Z","timestamp":1766743522000},"page":"874-884","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["No increased risk of spinal cerebrospinal fluid leak after spinal manipulative therapy: A retrospective cohort study"],"prefix":"10.1002","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4714-1076","authenticated-orcid":false,"given":"Robert J.","family":"Trager","sequence":"first","affiliation":[{"name":"Connor Whole Health University Hospitals Cleveland Medical Center Cleveland Ohio USA"},{"name":"Department of Family Medicine and Community Health, School of Medicine 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