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Cervical artery dissection (CeAD) is rare after chiropractic manipulation, though associated cases are younger women with vertebral dissections. The absolute risk remains extremely low despite millions of annual procedures.

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Area of Science:

  • Neurology
  • Vascular Medicine
  • Public Health

Background:

  • Cervical artery dissection (CeAD) is a significant cause of ischemic stroke in young adults.
  • Millions of chiropractic cervical manipulations occur annually in the US, with a controversial link to CeAD.

Purpose of the Study:

  • To investigate the association between chiropractic cervical manipulation and CeAD.
  • To identify clinical features of manipulation-associated CeAD.

Main Methods:

  • Analysis of the multicenter STOP-CAD registry (n=4023) for CeAD cases.
  • Comparison of demographics and clinical features between manipulation-associated and nonmanipulation-associated CeAD.
  • Multivariable logistic regression to identify factors associated with manipulation-related CeAD.

Main Results:

  • Approximately 5% of CeAD cases in the registry reported prior chiropractic manipulation.
  • Manipulation-associated CeAD occurred more frequently in younger females, those without diabetes, and with neck pain.
  • Higher odds of isolated vertebral artery dissection were noted in manipulation-associated cases.

Conclusions:

  • The absolute risk of CeAD following chiropractic manipulation is very low, despite the high volume of procedures.
  • Manipulation-associated CeAD cases present with distinct clinical characteristics, often involving younger women and vertebral arteries.
  • The causal relationship remains unclear: manipulation as a trigger or early CeAD symptoms prompting manipulation.