Chiropractic spinal manipulation (CSM) is often used as a treatment for neck pain. However, its effectiveness is unclear. The aim of this article was to evaluate systematically and critically the effectiveness of CSM for neck pain. Six electronic databases were searched for all relevant randomized clinical trials. Strict inclusion/exclusion criteria had been predefined. Key data were validated and extracted. Methodologic quality was assessed by using the Jadad score. Statistical pooling was anticipated but was deemed not feasible. Four studies met the inclusion/exclusion criteria. Two studies were on single interventions, and 2 included series of CSM treatments, both with a 12-month follow-up. The 2 short-term trials used spinal mobilization as a control intervention. The 2 long-term studies compared CSM with exercise therapy. None of the 4 trials convincingly demonstrated the superiority of CSM over control interventions. In conclusion, the notion that CSM is more effective than conventional exercise treatment in the treatment of neck pain was not supported by rigorous trial data.