Speaker: Date: Topic
David E. Thaler, MD, PhD
May 21, 2014
The Case of Ms LL, or Illegal Use of Hands: The Risk of Chiropractic Manipulation and Cervical Arterial Dissections
Responsibility for Content
The WebEx video, PowerPoint presentation, take-away points and article links were sent by the Medical Library and the CME Committee.
Diane E. Young, Information Specialist
Article: Beware the Spinal Trap by Simon Singh
Take-Away Points of the Presentation
1. Cervical spine manipulation therapy (SMT) has been associated with cervical artery dissection and stroke. The causal connection between SMT and dissection comes from the known stretching of the vertebral and carotid arteries that occurs during neck manipulation. Neck manipulation is an independent risk factor for vertebral artery dissection.
2. A link has been suggested between an artery-to-artery embolism in highly calcified cervical vessels as an additional risk factor for SMT-induced embolism in the absence of dissection.
3. Carotid dissection can be asymptomatic, and therefore, its incidence may be underestimated.
Links to Articles Cited in the Presentation
- Cassidy JD: Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case
- Dandamudi VS; Thaler DE et al: Cerebral embolus following chiropractic manipulation in a patient wit
- Haldeman S: Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ
- Lee KP: Neurologic complications following chiropractic manipulation: a survey of California neurolo
- Meade TW: Low back pain of mechanical origin: randomised comparison of chiropractic and hospital out
- Meeker WC: Chiropractic: a profession at the crossroads of mainstream and alternative medicine. Ann
- Parenti G: Vertebral and carotid artery dissection following chiropractic cervical manipulation. Neu
- Rinsky LA: A cervical spinal cord injury following chiropractic manipulation. Paraplegia 1976;13:223
- Rothwell DM: Chiropractic manipulation and stroke: a population-based case-control study. Stroke 200
- Stevinson C: Neurological complications of cervical spine manipulation. J R Soc Med 2001;94(3):107-1