Thursday, May 17, 2007

Cervical spine manipulation and stroke

Southern Medical Journal reports a case of fatal posterior circulation stroke following chiropractic manipulation of the cervical spine and discusses the literature. The authors conclude:

Since there is a large amount of evidence from many reports regarding an association between neurologic damage and cervical manipulation, and because there are no identifiable risk factors, anyone who receives CSMT can be at risk of neurologic damage. It is important for patients to be well informed before undergoing this kind of procedure and for physicians to recognize the early symptoms of this complication so that catastrophic consequences can be avoided.


Anonymous said...

Quebec Coroner: Patient Death Caused by Chiropractic Adjustment

This is significant because it is widely distributed to chiros, and they have long claimed that CSMT was not causing strokes.

Anonymous said...

Chiropractors know about the rare risk for strokes and are attempting to identify populations at risk and utilizing informed consents. The big question is this if chiropractic neck manipulations cause strokes one time in a million, and Tylenol causes 1 death (from acute hepatotoxicity) per 2.2 million tablets why is there not a major outcry against using Tylenol
Here is an article comparing acceptable risks:

Anonymous said...

Simple blood test may be the best screening tool...

Document title:
Hyperhomocysteinemia: A potential risk factor for cervical artery dissection following chiropractic manipulation of the cervical spine


..cervical artery dissection (CAD) associated with chiropractic manipulation of the cervical spine, and the risk factors predisposing to vascular damage are still unknown. In the present study we measured fasting total plasma homocysteine (tHcy) concentration in 4 subjects with manipulation-related CAD selected from a larger series of patients with spontaneous dissection of the neck arteries (sCAD) and in a group of 36 control subjects. C677T MTHFR genotypes and 844ins68bp CBS genotypes were also determined. Median tHcy levels were significantly (P=0.002) higher in patients with manipulation-related CAD (18.2 μmol/l, range 14.3 to 30.0) compared with controls (8.9 μmol/l, range 5 to 17.3) and not significantly different (P=0.129) from those observed in patients with sCAD (13.9 μmol/l, range 7 to 32.8). No significant difference in the distribution of genotypes was observed in the three groups. Hyperhomocysteinemia may represent a potential risk factor for manipulation-related CAD, leading to structural abnormalities of the arterial wall and increasing the susceptibility to mechanical stress.

PEZZINI Alessandro (1) ; DEL ZOTTO Elisabetta (1) ; PADOVANI Alessandro (1) ;

Journal Title:
Journal of neurology (J. neurol.) ISSN 0340-5354 CODEN JNRYA9

2002, vol. 249, no10, pp. 1401-1403 (16 ref.) a side note, other research has shown that taking certian B vitamins has been shown to decrease homocysteinemia, but does NOT cause an associated decrease in risk for cardiovascular disease (including stroke).