Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management

Albuquerque, Felipe C.; Hu, Yin; Dashti, Shervin R.; Abla, Adib A.; Clark, Justin C.; Alkire, Brian; Theodore, Nicholas; McDougall, Cameron G.

doi:10.3171/2011.8.jns111212

Cited by 66 publications

(59 citation statements)

References 44 publications

(43 reference statements)

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“…66,102,[149][150][151] An estimated 50% of total neck rotation occurs at the atlanto-axial joint, subjecting the VA at this level to higher bending forces than those encountered in the lower neck. 88 Rotation and extension of the neck predispose the VA to dissection by stretching the vessel against either the atlas or posterior atlanto-occipital membrane, which the VA penetrates as it courses superiorly into the skull.…”

Section: Postulated Mechanisms Of Vessel Injurymentioning

confidence: 99%

“…154 Dissection of the VA can propagate rostrally to involve the intracranial (V4) segment and the basilar artery. 66 Isolated injuries to the V4 segment are likely the result of torsion of the vessel as it pierces the dura mater. 66 Dissecting aneurysms of this arterial segment can produce subarachnoid hemorrhage (SAH), although this has not been associated with CMT.…”

Section: Postulated Mechanisms Of Vessel Injurymentioning

confidence: 99%

“…66 Isolated injuries to the V4 segment are likely the result of torsion of the vessel as it pierces the dura mater. 66 Dissecting aneurysms of this arterial segment can produce subarachnoid hemorrhage (SAH), although this has not been associated with CMT. 66,88,148 The ICA may potentially be injured during cervical manipulation.…”

Section: Postulated Mechanisms Of Vessel Injurymentioning

confidence: 99%

“…Cervical manipulative therapy (CMT) has been demonstrated to be associated with CD in several studies. [66][67][68] …”

Section: Table 1 Factors Associated With CDmentioning

confidence: 99%

See 3 more Smart Citations

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

Self Cite

175

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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Section: Postulated Mechanisms Of Vessel Injurymentioning

confidence: 99%

Section: Postulated Mechanisms Of Vessel Injurymentioning

confidence: 99%

Section: Postulated Mechanisms Of Vessel Injurymentioning

confidence: 99%

“…Cervical manipulative therapy (CMT) has been demonstrated to be associated with CD in several studies. [66][67][68] …”

Section: Table 1 Factors Associated With CDmentioning

confidence: 99%

See 2 more Smart Citations

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

Self Cite

175

View full text Add to dashboard Cite

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“…This finding further supports systematic reviews that have reported inconsistent and inconclusive effectiveness of physical treatments in tension-type headache aimed at mobilization. 14, 24,26 Considering these results and reported risks of cervical high-velocity thrust mobilization techniques, 1 clinicians should reconsider the use of these techniques in participants with CTTH.…”

Section: Discussion Main Findingsmentioning

confidence: 99%

The Working Mechanism of Manual Therapy in Participants With Chronic Tension-Type Headache

Castien

Blankenstein²,

Windt³

et al. 2013

J Orthop Sports Phys Ther

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Chronic tension-type headache (CTTH) is associated with cervical spine impairments, including restricted range of motion (ROM) of the cervical spine, reduced neck flexor endurance, and greater forward head posture. 13,15,17,27,30 These associations have led to the development of a biomechanical model for CTTH. According to this conceptual model, cervical dysfunction elicits headache through peripheral or central pain mechanisms; therefore, improvement of cervical dysfunction by physical treatment should reduce headache. 5,18,19 Based on this model, we conducted a randomized clinical trial (RCT) to determine the effectiveness of multimodal manual therapy, including mobilization of the cervical spine, isometric training of neck flexors, and posture correction. A reduction in headache days of 50% or greater was the clinically relevant outcome.2 A significant difference of 87.5% versus 27.5% in outcome was found in favor of manual therapy, compared to usual care by the general practitioner, in participants with CTTH. 8The extent to which specific elements (mobilization, isometric training of neck flexors, or posture correction) contribute to the effectiveness of manual therapy is unknown, and information about the working mechanisms of manual therapy in participants with headache is urgently needed. 5,19 The biomechanical model mentioned above suggests that increased ROM of the cervical spine, increased neck flexor endurance, and a less pronounced forward head posture may offer potential explanations for the effect of manual therapy in reducing headache frequency. To explore the working mechanism of manual therapy, we investigated whether the above aspects of cervical spine function (cervical ROM, neck flexor endurance, and forward head posture) were mediators of the effect of manual therapy on headache frequency. METHODS Participants For the mediation analyses, we used the combined data obtained from 2 studies, a multicenter, prag-T T STUDY DESIGN: Prospective longitudinal study. T T OBJECTIVE:To explore the working mechanism of manual therapy, we investigated whether 3 cervical spine variables were mediators of the effect of manual therapy on headache frequency. T T BACKGROUND: Manual therapy has beenshown to reduce headache frequency in participants with chronic tension-type headache (CTTH). To what extent specific elements of treatment contribute to the effectiveness of manual therapy in CTTH is unknown. T T METHODS:One hundred eighty-two participants with CTTH participated in a prospective longitudinal study: 142 underwent manual therapy and 40 participants received usual care by their general practitioner. Regression analysis was performed according to the steps described by Baron and Kenny, and the proportion of mediated effect was estimated for 3 potential mediators: (1) cervical range of motion, (2) neck flexor endurance, and (3) forward head posture. Outcome was defined as a 50% or greater reduction in headache days.

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Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment

Gross

Langevin

Burnie

et al. 2015

Cochrane Database of Systematic Reviews

158

136

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Although support can be found for use of thoracic manipulation versus control for neck pain, function and QoL, results for cervical manipulation and mobilisation versus control are few and diverse. Publication bias cannot be ruled out. Research designed to protect against various biases is needed. Findings suggest that manipulation and mobilisation present similar results for every outcome at immediate/short/intermediate-term follow-up. Multiple cervical manipulation sessions may provide better pain relief and functional improvement than certain medications at immediate/intermediate/long-term follow-up. Since the risk of rare but serious adverse events for manipulation exists, further high-quality research focusing on mobilisation and comparing mobilisation or manipulation versus other treatment options is needed to guide clinicians in their optimal treatment choices.

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Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management

Cited by 66 publications

References 44 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

The Working Mechanism of Manual Therapy in Participants With Chronic Tension-Type Headache

Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment

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