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Chiropractic Research Review

Cervical Spine Manipulation and Cerebrovascular Ischemia

The growing acceptance of cervical manipulation as an effective treatment for head and neck conditions has necessitated the determination of possible side effects of this treatment, and ways to avoid them.

Over the past six decades, cerebrovascular accidents have been reported to be associated with cervical manipulation in 117 cases that have been published in the English literature.

These events are rare, only occurring after one in 400,0004 million manipulations. Research has attempted to identify characteristics of patients susceptible to cerebrovascular dissection, such as age; gender; hypertension; smoking; migraines; and drug use, so that those at high risk of ischemia after cervical adjustments can be recognized. However, due to the rarity of cerebrovascular events, it is difficult to conduct such studies.

The authors of this study reviewed 64 cases of cerebrovascular accidents associated with manipulation in an attempt to reveal risk factors associated with occurrence. All cases involved detailed malpractice claims; the cases were examined for possible links to factors such as medical history, chronic dysfunction, and drug use.

Women were more likely than men to suffer a cerebrovascular ischemic event, with 64% of cases being women. The age of case subjects ranged from 24-53 - the age group most likely to seek manipulation. Besides these factors, no prominent risk factors were associated with the condition. Symptoms of ischemia included loss of coordination, numbness, and speech and visual problems, which most commonly occurred within 48 hours of manipulation, and within 30 minutes in 75% of cases.

Conclusion: Cerebrovascular accidents following manipulation seem to be unpredictable. At present, there are few warning signs to identify patients at higher risk for ischemia following manipulation, but the possible risk of this rare problem should be explained to patients. Ischemic accidents should be considered rare complications of cervical spine manipulation.

Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy. Spine 2002:27(1), pp. 49-55.

Chiropractic Research Review

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