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Daily Archives: March 27, 2013

The Quality of Reports on Cervical Arterial Dissection Following Cervical Spinal Manipulation

By |March 27, 2013|Evidence-based Medicine, Spinal Manipulation, Stroke|

The Quality of Reports on Cervical Arterial Dissection Following Cervical Spinal Manipulation

The Chiro.Org Blog

SOURCE:   PLoS ONE 2013 (Mar 20); 8 (3): e59170

Shari Wynd, Michael Westaway, Sunita Vohra, Greg Kawchuk

Texas Chiropractic College,
Pasadena, Texas, United States of America.

Background   Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.

Purpose   1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and
2) assess the quality of these reports.

Methods   A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.

Results   Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.

Conclusions   This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.

Copyright: ¬© 2013 Wynd et al.   This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding:   Greg Kawchuk receives salary support from the Canada Research Chairs program. Sunita Vohra receives salary support from Alberta Innovates-Health Solutions. Training support for Shari Wynd was provided by the Alberta Canadian Institutes of Health Research (CIHR) Training Program in Bone and Joint Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests:   The authors have declared that no competing interests exist.

From the Full-Text Article:


In the area of harms reporting, one topic that has received significant attention is cervical spinal manipulation therapy (cSMT), an intervention most often administered by chiropractors [1, 2] to treat musculoskeletal complaints of the head and neck [3] including headaches [4]. If harms are associated with cSMT, they most commonly involve additional head and neck pain [2]. While these adverse events tend to be self-limiting [2], more serious adverse events have been reported such as neurovascular sequelae and stroke. More specifically, injuries such as cervical artery dissection (CAD), whether vertebral, internal carotid, or vertebrobasilar, have been reported to be associated with cSMT [5-7]. Although this subset of adverse events appears to occur infrequently [1, 8, 9], understanding the relation between CADs, stroke and cSMT is important given the medical [7], societal [1], economic [9], and legal [8] implications of any event leading to cerebrovascular compromise.

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