Rare Or Common: A Matter of Perspective

By Brad McKechnie, DC, DACAN
In a review of the complications concerning various treatment regimens employed in health care, an interesting observation can be made as to the relative frequency of complications and the manner in which they are reported in the literature.

For example, biomedical literature concerning upper cervical manipulation and vertebrobasilar arterial insufficiency (VBAI) tends to describe vertebrobasilar infarcts as common consequences of upper cervical manipulation. This trend is seen throughout allopathic literature concerning this subject. The reported incidence of VBAI in the literature runs from 1:300,0001 to 1:11,000,000.2 Critics of chiropractic consider these numbers to indicate that VBAI is a common consequence of manipulation to the upper cervical spine.

In contrast, anterior perforations in lumbar discectomy leading to vascular complications have a mortality rate of 37-61 percent.3 The article reporting this complication described it as "a rare but serious complication" with an incidence of 1:575 patients.

The American public is bombarded by advertising every day concerning the use of NSAIDS for musculoskeletal pain control. This medication regimen is said to have rare side effects by those advocating its usage. In the Greater Newcastle area, a region with a population of 390,000 people, there were 1,003 patients admitted for gastrointestinal complications of NSAID usage from January 1980 to June 1986. Of the 1,003 admissions, 81 patients died. NSAIDS are considered to be responsible for up to 200 deaths per year in Great Britain.4 Statistics on the same medication regimen from New South Wales indicate that there is a 1:135,000 chance that an NSAID regimen may cause death. Yet, biomedical literature considers these rates to be rare and worth the risk. If one takes the mortality rate as determined in New South Wales and compares it to the 1:11,000,000 complication rate previously cited, we find that a patient is 81 times more likely to die from NSAID therapy than to suffer complications from cervical manipulation.

As one can see, the terms rare and common are relative terms that do little to indicate the complication rates that are associated with various procedures used in health care today.


  1. Gutmann, G. "Injuries to the vertebral artery caused by manual therapy." Manual Medicine 1983; volume 21.


  2. Hosek, R.S., et al. "Cervical manipulation." JAMA 1981; 245(9).


  3. Anda, S., et al. "Anterior perforations in lumbar discectomies: A report of four cases of vascular complications and a CT study of the pre-vertebral lumbar anatomy." Spine 1991; 16(1).


  4. Henry, David A., et al. "Fatal peptic ulcer complications and the use of non-steroidal/anti-inflammatory drugs, aspirin, and corticosteroids." British Medical Journal 1987; volume 295.

Brad McKechnie, D.C., D.A.C.A.N.
Pasadena, Texas

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