The association between cervical artery dissection and spinal manipulation among US adults

Whedon, James M.; Petersen, Curtis L.; Schoellkopf, William J.; Haldeman, Scott; MacKenzie, Todd A.; Lurie, Jon D.

doi:10.1007/s00586-023-07844-9

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…Many well-known studies related to this topic were excluded. Rothwell et al (2001) [ 10 ], Kosloff et al (2015) [ 11 ], Church et al (2016) [ 6 ], Cassidy et al (2017) [ 4 ], Kennell et al (2017) [ 12 ], Whedon et al (2022) [ 13 ], and Whedon et al (2023) [ 14 ] were excluded, as they did not propose any mechanism of causation of immediate stroke from CSM. Rothwell et al did reference Norris et al (2000) [ 15 ], which proposed a plausible mechanism of causation and was included in our study.…”

Section: Reviewmentioning

confidence: 99%

Plausible Mechanisms of Causation of Immediate Stroke by Cervical Spine Manipulation: A Narrative Review

Brown

2024

Cureus

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It has been proposed that cervical spine manipulation (CSM) can cause dissection in healthy cervical arteries, with resultant immediate stroke. However, research does not support a causal association between CSM and cervical artery dissection (CAD) in healthy cervical arteries. The objective of this study was to review the literature to identify plausible mechanisms of causation of immediate stroke by CSM. Immediate stroke is defined as a stroke occurring within seconds or minutes of CSM. Our review found plausible thromboembolic and thrombotic mechanisms of causation of immediate stroke by CSM in the literature. The common premise of these mechanisms is CAD being present before CSM, not occurring as a result of CSM. These mechanisms of causation have clinical and medicolegal implications for physicians performing CSM.

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Section: Reviewmentioning

confidence: 99%

Plausible Mechanisms of Causation of Immediate Stroke by Cervical Spine Manipulation: A Narrative Review

Brown

2024

Cureus

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“…Previous studies have proposed that a common treatment used by chiropractors, chiropractic spinal manipulation (CSM), may trigger VAD by damaging, occluding, or causing vasospasm or thrombosis in the vertebral arteries [9,10]. However, this hypothesis has been called into question by recent large observational studies which found no increase in the risk of VAD or vertebrobasilar stroke among patients receiving CSM [11][12][13][14]. These findings support the idea that neck pain and headache due to undiagnosed VAD may prompt patients to visit a chiropractor, as opposed to CSM causing VAD de novo (i.e., confounding by indication or protopathic bias [11,15]).…”

Section: Introductionmentioning

confidence: 99%

Symptoms of Patients With Vertebral Artery Dissection Presenting to Chiropractors: A Systematic Review and Meta-Analysis

Trager,

Troutner,

Pikus

et al. 2023

Cureus

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Early symptoms of vertebral artery dissection (VAD) may be nonspecific, including neck pain and headache. Neck pain and headache are also common reasons for patients to seek chiropractic care. We hypothesized that neck pain and/or headache would be the most prevalent symptoms among patients with undiagnosed VAD presenting to chiropractors compared to dizziness or other symptoms. We searched PubMed, Ovid, the Index to Chiropractic Literature, Google Scholar, and gray literature through September 2023 for observational studies describing patients aged ≥10 with previously undiagnosed VAD presenting to a chiropractor. Article selection, data extraction, and quality assessment were performed in duplicate. We synthesized the point prevalence of symptoms and other clinical features. We included 10 case reports describing 10 patients (mean age = 37, SD = 7, 60% female). All patients had either neck pain or headache (100%; 95% confidence interval (CI) = 100%-100%). The most prevalent individual symptoms were neck pain (90%; 95% CI = 71%-100%), headache (80%; 95% CI = 55%-100%), visual disturbance (50%; 95% CI = 19%-81%), and dizziness (40%; 95% CI = 10%-70%). The certainty of results was very low due to publication bias. While our findings suggest that neck pain and/or headache are the most prevalent symptoms among patients with undiagnosed VAD visiting a chiropractor, the small sample size and reliance on case reports preclude any definitive conclusions. Further research with larger sample sizes, control groups, and better control of confounders is required to corroborate these results. Chiropractors should be aware of VAD features and refer suspected patients for emergency care.

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Letter to the Editor

Meyer,

Trager,

Daniels

et al. 2024

Am J Forensic Med Pathol

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The association between cervical artery dissection and spinal manipulation among US adults

Cited by 4 publications

References 24 publications

Plausible Mechanisms of Causation of Immediate Stroke by Cervical Spine Manipulation: A Narrative Review

Plausible Mechanisms of Causation of Immediate Stroke by Cervical Spine Manipulation: A Narrative Review

Symptoms of Patients With Vertebral Artery Dissection Presenting to Chiropractors: A Systematic Review and Meta-Analysis

Letter to the Editor

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