Cerebrovascular Complications Associated with Spinal Manipulation

Abstract

Spinal manipulation is a form of manual therapy often employed by chiropractors, osteopaths, medical doctors, physiotherapists and other healthcare professionals. Its widespread use renders the continuous, critical assessment of its safety an important task. The aim of this systematic review was to summarise the recent (1995-2003) evidence on the subject. Computerised literature searches were carried out without language restrictions. Only articles with original data pertaining to the cerebrovascular risks of spinal manipulation were included. Numerous case reports, case series, retrospective investigations and prospective studies were located. In total, more than 300 patients were affected. The most frequently reported complication was stroke due to arterial dissection after cervical spinal manipulation. Considering the popularity of spinal manipulative therapies, the overall incidence of such complications is probably low; however, no reliable figures can be generated through this or any other data available to date. It is concluded that serious cerebrovascular complications of spinal manipulation continue to be reported. Their incidence is unknown. Large and rigorous prospective studies are necessary in order to define the risks of spinal manipulation accurately.

Beliefs and Practice Patterns in Spinal Manipulation and Spinal Motion Palpation Reported by Canadian Manipulative Physiotherapists

“…35 Defining practice patterns by self-report, despite the inherent limitations of this approach, is a useful preliminary step in investigating the potential for adverse events in manipulative physiotherapy. At present, there is little evidence defining serious adverse events that have occurred following physiotherapy intervention 26,36 ; the evidence for adverse events following manipulation is primarily from chiropractic practice data. 26,37 Differences in rates of adverse events between professions may be due to differences in manipulative techniques, differences in rates of use (i.e., chiropractors use these techniques more than other disciplines do), and the fact that these are rare events.…”

Manual Therapy and Cervical Arterial Dysfunction, Directions for the Future: A Clinical Perspective

“…Complications of MT treatment related to the ICAs have been reported 10,37 . Consideration of the reported cases alone will not lead to a full understanding of the complete nature and details of ICA pathologies.…”

“…Primarily, there is the argument of under-reporting (i.e., not all cases are reported or published). A recent review suggested a 100% under-reporting rate, based on fi ndings of 32 cases within the UK in one year, none of which had been previously reported 10 . Most structured attempts to calculate risk have been made using questionnaire surveys of clinicians.…”

Fatalities after CAM: an overview

“…Of 40 published case reports of serious adverse effects associated with spinal manipulation, nine failed to provide any information about the clinical outcome. 18 Incomplete reporting of outcomes might therefore further increase the true number of fatalities. Considering the implausibility of the basic assumptions of chiropractic, 19 its lack of efficacy for many conditions, 20 and its risks, it is hard to find good reasons for recommending this treatment.…”