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Chiropractic Research Review

Trauma and Spinal Manipulation:

"Vertebrobasilar artery dissection and occlusion leading to brain stem and cerebellar ischemia and infarction are rare but often devastating and unexpected causes of stroke." Risk factors for these complications have been discussed in the literature.

Although many vertebrobasilar artery dissections have been considered spontaneous because no causal event could be isolated, there has been speculation on the potential role of spinal manipulation in these events.

This literature review of 179 articles (documenting 370 cases of vertebral artery dissection or occlusion) assessed data pertaining to precipitating neck movements and risk factors for vertebrobasilar artery dissection, in an attempt to determine the potential for these complications to be minimized.
Results: Spontaneous onset accounted for 160 of the cases reported; 115 cases of onset after spinal manipulation; 58 cases associated with minor trauma; and 37 cases associated with major trauma. It was not possible to identify a specific neck movement or trauma (including different forms of cervical spine manipulation) that could be considered the causative factor in many of the cases.

Because of the rarity of vertebral artery dissection, little conclusive data exists; most reports are single case studies or case series. Still, there are numerous opinions about what precipitates vertebral artery dissection. The authors believe that, considering these results, "vertebrobasilar artery dissection after neck movement, trauma or manipulation should be considered a rare, random, unpredictable complication associated with these activities."

Haldeman S, Kohlbeck FJ, McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine, April 15, 1999:24(8), pp785-94.

Chiropractic Research Review

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