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Stroke, cerebral artery dissection, and cervical spine manipulation therapy
Scott Haldeman1, Frank J Kohlbeck, Marion McGregor
1Department of Research, Southern California University of Health Sciences, USA.
Journal of Neurology
|August 27, 2002
Summary
Cervical manipulation therapy can rarely cause stroke, particularly vertebrobasilar dissection. This unpredictable complication may occur with any technique and is often preceded by unusual head or neck pain.
Area of Science:
- Neurology
- Orthopedics
- Public Health
Background:
- Cervical spine manipulation therapy is a common treatment for neck pain.
- Stroke is an infrequent but serious adverse event associated with this therapy.
- Identifying at-risk patients or specific manipulation types has proven unsuccessful.
Purpose of the Study:
- To evaluate the characteristics of cervical manipulation therapy and patient presentation in cases of stroke.
- To analyze medical-legal case files of patients experiencing stroke after manipulation.
- To understand the relationship between cervical manipulation and stroke complications.
Main Methods:
- Retrospective review of 64 medical-legal cases of stroke temporally associated with cervical spine manipulation.
- Data abstraction by three researchers using a standardized instrument.
- Consensus review to ensure agreement on case file content.
Main Results:
- 92% of cases presented with pre-existing head and/or neck pain.
- 25% of cases reported sudden onset of new, unusual headache and neck pain, potentially indicating dissection.
- Strokes occurred at any point during treatment, regardless of manipulation technique or 'dose'.
Conclusions:
- Stroke, especially vertebrobasilar dissection, is a random and unpredictable complication of cervical manipulation.
- Any neck movement, including manipulation, carries this risk.
- Sudden, unusual head/neck pain may signal a dissection in progress, with manipulation acting as a final trigger.