Tyler Snodgrass, DC (’24), with the help of three other Logan University alumni, published his first letter to the editor in Anesthesia & Analgesia (A&A) Practice. The project started when Dr. Snodgrass, a trimester 9 Doctor of Chiropractic (DC) student at Logan at the time, discovered potential biases in an A&A Practice case report.
After reading the case report, Dr. Snodgrass went to the evidence. “I learned to identify and critically evaluate scholarly publications through an information literacy class taught by Kimberly Cerf, DC (’18), MS (’17),” Dr. Snodgrass said. “The case report discussed a potential adverse event related to chiropractic manipulation. The authors claimed that spinal manipulation caused a dural tear and subsequent cerebrospinal fluid leak, but the clinical factors, such as age, gender and body mass index, and evidence used by the authors, limited the validity of the claim.”
He shared the report with Zachary Cupler DC, MS, lead attending at the VA Butler Healthcare System, where Dr. Snodgrass completed his clinical rotation. Aligned in their response to the peer review, they assembled a team of clinical and research experts to submit a letter to the editor of A&A Practice, including Drs. Cupler and Snodgrass; Robert Trager, DC (’13), DIANM; Clinton Daniels, DC (’10), MS (’10); and Patrick Battaglia, DC (’12), DACBR.
“I had the opportunity to be lead author on the letter, but each member played an integral role in guiding me through this process,” Dr. Snodgrass said. “They introduced me to the academic world of research, from preparation to synthesizing information and drafting submissions.”
After several rounds of revision, the team finalized a letter within two weeks of identifying the report. The letter stated that a causal relationship between chiropractic spinal manipulative therapy and cerebrospinal fluid leaks was not supported by the original evidence. It highlighted how the analysis of evidence, along with overlooked clinical factors and biases, may have led to flawed conclusions. The team emphasized the importance of clinical reasoning, proper interpretation of imaging findings and the necessity of rigorous investigations before assigning causality.
“This project is a great learning experience for DC students,” Dr. Cupler said. “They get to see how a rapid response group can form and dissect a case report with critical appraisal skills.”
The letter was accepted by the editor in October 2024 and published in March 2025. Dr. Snodgrass will continue to gain experience in integrated clinical care and was officially matched to the VA Finger Lakes Healthcare System Chiropractic Residency Program.
“The process of submitting a letter to the editor sparked my interest to move on to bigger projects and produce more literature for the chiropractic profession,” Dr. Snodgrass said. “It gave me a hunger to learn more about research and showed me that it’s possible to be both a clinician and a researcher.”