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Chiropractic Research Review

Fewer Cerebrovascular Accidents after Manipulation

The integration of chiropractic into mainstream health care in Canada, the U.S., the United Kingdom, and Denmark has led to more interest in possible complications of spinal adjustments, such as arterial dissection following cervical manipulation.

This research paper estimated the rate of stroke in a series of cases covered by the Canadian Chiropractic Protective Association (CCPA).

The authors reviewed malpractice records from the CCPA to evaluate stroke claims following chiropractic treatment between 1988 and 1997. This number was compared to the total number of cervical manipulations done yearly by chiropractors covered by the CCPA. Yearly adjustments were determined based on a questionnaire completed by 77.8% of members.

Following cervical manipulation, there were 20 cases of minor neurological complications, which were not diagnosed as stroke by a neurologist. Twenty-three cases of stroke or vertebral arterial dissection after chiropractic adjustment were recorded. Approximately 134.5 million cervical adjustments were carried out by chiropractors over the 10-year period. Based on the fact that Canada has 4,500 licensed chiropractors, the odds that a chiropractor will be made aware of a stroke after performing a cervical manipulation are as follows:

* one per 8.06 million office visits;

* one per 5.85 million cervical manipulations;

* one per 1,430 chiropractic practice years; and

* one per 48 chiropractic practice careers.


Note: These data indicate that stroke is much less likely in chiropractic patients than has been estimated by neurologists (about one per 500,000-1 million). Those who experience stroke following manipulation are most likely female, and often display the first symptoms within 20 minutes. Access the full article on line at http://www.cma.ca/cmaj/vol-165/issue-7/pdf/pg905.pdf.

Haldeman S, Carey P, Townsend M, et al. Arterial dissections following cervical manipulation: The chiropractic experience. Canadian Medical Association Journal 2001:165(7), pp. 905-906.

Chiropractic Research Review

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