Cervical Artery Dissection Diagnosed Following Chiropractic Cervical Manipulation: A STOP-CAD Subanalysis

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.