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Does cervical manipulative therapy cause vertebral artery dissection and stroke?
Madeline L Miley1, Kay E Wellik, Dean M Wingerchuk
1Division of Neurosciences, Faculty of Science, Loyola University, Chicago, IL, USA.
The Neurologist
|January 16, 2008
Summary
Cervical manipulative therapy (CMT) shows weak to moderate evidence of causing vertebral arterial dissection (VAD) and stroke, particularly in individuals under 45. The incidence is estimated at 1.3 cases per 100,000 in this demographic.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Cervical manipulative therapy (CMT) is a common treatment for neck pain.
- Vertebral arterial dissection (VAD) can lead to ischemic stroke, especially in younger individuals.
- The potential link between CMT and VAD/stroke requires rigorous investigation.
Observation:
- A systematic review of 26 high-quality studies was conducted.
- Evidence suggests a causal link between CMT and VAD/stroke, particularly in patients under 45.
- Younger stroke patients were 5 times more likely to have undergone CMT recently.
Findings:
- Weak to moderate evidence supports CMT as a cause of VAD and stroke.
- No significant association was found in individuals aged 45 and older.
- The estimated incidence of CMT-associated VAD/stroke is 1.3 per 100,000 in those under 45.
Implications:
- The risk of VAD and stroke associated with CMT must be weighed against its therapeutic benefits.
- Further research using prospective cohort studies is needed to clarify the risks and benefits of CMT.
- Clinical guidelines may need to incorporate these findings for patient safety.
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