Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection:
No Evidence for Causation
SOURCE: Cureus 2016 (Feb 16); 8 (2): e498
Ephraim W. Church, MD, Emily P. Sieg, MD,
Omar Zalatimo, MD, Namath S. Hussain, MD,
Michael Glantz, MD, Robert E. Harbaugh, MD
Department of Neurosurgery,
Penn State Hershey Medical Center
BACKGROUND: Case reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD.
METHODS: Search terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria.
RESULTS: Our search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was “very low.”
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