Neck Manipulation and Cervical Arterial Dissection: A Smoking Gun?

Authors: Biller J et al., Stroke 2014 Aug 7;

A statement from the AHA/ASA notes an association, but causation is unclear.

Recent epidemiologic studies have suggested a rising frequency of stroke in young adults. Arterial dissection is one of the leading causes of stroke in young adults. Several activities involving hyperextension of the neck have been reported to be associated with arterial dissection, including chiropractic neck adjustment. A scientific panel reviewed the existing literature (mostly case-control studies) on the relation between neck adjustment and arterial dissection. The panel determined that the mechanical force imposed by chiropractic therapy could result in arterial dissection and that patients should be made aware of the risk. They concluded that an association exists but that it cannot be stated with certainty that neck manipulation causes stroke.

Comment

In many cases, patients with spontaneous carotid or vertebral dissection present with severe neck pain and may seek chiropractic services. In such instances, the dissection may precede neck adjustment. In other cases, neurologic symptoms occur within minutes or hours after chiropractic treatment, making the etiologic link with stroke much stronger. It is very reasonable to convey to patients that there is a potential risk for stroke (although the risk is likely low in absolute terms) with cervical adjustment. Patients with sudden onset of severe neck pain should be investigated for dissection before undergoing neck manipulation.