Does Cervical Manipulative Therapy Cause Vertebral Artery Dissection and Stroke?

@article{Miley2008DoesCM,
  title={Does Cervical Manipulative Therapy Cause Vertebral Artery Dissection and Stroke?},
  author={Madeline L. Miley and Kay E. Wellik and Dean M. Wingerchuk and Bart M. Demaerschalk},
  journal={The Neurologist},
  year={2008},
  volume={14},
  pages={66-73}
}
OBJECTIVE Does cervical manipulative therapy (CMT) cause vertebral arterial dissection (VAD) and subsequent ischemic stroke. [...] Key Method Participants included neuroscience students, consultant neurologists, clinical epidemiologists, medical librarians, and clinical content experts. A critically appraised topic format was employed, starting with a clinical scenario and structured question.Expand
Biller et al Cervical Arterial Dissections and Cervical Manipulative Therapy 3157
Purpose—Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults. The aim of this scientific statement is to review the current state of evidence
Cervical Arterial Dissections and Association With Cervical Manipulative Therapy: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association
TLDR
Although current biomechanical evidence is insufficient to establish the claim that CMT causes CD, clinical reports suggest that mechanical forces play a role in a considerable number of CDs and most population controlled studies have found an association between CMT and VAD stroke in young patients.
Pathologic Evaluation of the Cervical Spine Following Surgical and Chiropractic Interventions
TLDR
This study presents a regimented, stepwise approach to the evaluation of the cervical spine in these difficult cases, promotes uniform assessment, facilitates diagnoses, and supports the accumulation of otherwise hard‐to‐come‐by reference material that can be of value in future cases.
Dissections of Cervical Arteries - Clinical Presentation, Course, and Therapy in 71 Consecutive Patients of a Single University Centre
TLDR
Patients treated initially with i.v. ASA tended to have a better outcome than patients who were anticoagulated, while low TSH indicated hyperthyreosis, while no patient was hypothyreotic, and CRP was elevated.
Migraine is associated with an increased risk of cervicocephalic arterial dissection
  • B. Demaerschalk
  • Medicine
    Cephalalgia : an international journal of headache
  • 2011
TLDR
Weak to moderate strength of evidence for causation exists between CMT and CAD and associated stroke, especially in young adults, and the confirmed association between migraine and CAD should fuel further scientific inquiries into the most probable and compelling mechanisms.
What are the risks of manual treatment of the spine? A scoping review for clinicians
TLDR
Existing literature indicates that benign adverse events following manual treatments to the spine are common, while serious adverse events are rare, and clinicians should ensure that patients are informed of risks during the consent process.
Does case misclassification threaten the validity of studies investigating the relationship between neck manipulation and vertebral artery dissection stroke? Yes
TLDR
There are several methodological challenges to understanding the association between neck manipulation and vertebral artery dissection, and valid case classification, accurate measurement of manipulative procedures, and addressing reverse causation bias should be top priorities for future research.
Current understanding of the relationship between cervical manipulation and stroke: what does it mean for the chiropractic profession?
  • D. Murphy
  • Medicine
    Chiropractic & osteopathy
  • 2010
TLDR
This new understanding has shifted the focus for the chiropractic physician from one of attempting to "screen" for "risk of complication to manipulation" to one of recognizing the patient who may be having VADS so that early diagnosis and intervention can be pursued.
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References

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Stroke, cerebral artery dissection, and cervical spine manipulation therapy
TLDR
It is suggested that stroke, particularly vertebrobasilar dissection, should be considered a random and unpredictable complication of any neck movement including cervical manipulation.
Spinal manipulative therapy is an independent risk factor for vertebral artery dissection
TLDR
This study attempts to control for confounding by indication as measured by neck pain before the stroke by selecting controls with stroke other than dissection, but several methodologic issues that threaten the validity of case-control studies require clarification.
ASSOCIATION OF INTERNAL CAROTID ARTERY DISSECTION AND CHIROPRACTIC MANIPULATION
TLDR
The medical literature does not support a clear causal relationship between CMT and ICAD, and reported cases are exceedingly scarce, and none support clear cause and effect.
Stroke following chiropractic manipulation of the cervical spine
TLDR
Patients at risk for stroke after chiropractic manipulation may not be identified a priori, and Neurological deficits may be severely disabling and are potentially life threatening.
Unpredictability of Cerebrovascular Ischemia Associated With Cervical Spine Manipulation Therapy: A Review of Sixty-Four Cases After Cervical Spine Manipulation
TLDR
Cerebrovascular accidents after manipulation appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach.
Cervical artery dissection. A comparison of highly dynamic mechanisms: manipulation versus motor vehicle collision.
TLDR
Perceived causation of reported cases of cervical artery dissection is more frequently attributed to chiropractic manipulative therapy procedures than to motor vehicle collision related injuries, even though the comparative biomechanical evidence makes such causation unlikely.
Vertebral Artery Dissection: Warning Symptoms, Clinical Features and Prognosis in 26 Patients
TLDR
The findings show that VA dissection affects mainly middle age persons and involves both sexes equally and headache and/or neck pain followed by vertigo or unilateral facial paresthesia is an important warning sign that may precede onset of stroke by several days.
Manipulation of the cervical spine: risks and benefits.
TLDR
Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements).
Manipulation of the Cervical Spine: Risks and Benefits
TLDR
Although the risk of injury associated with MCS appears to be small, this type of therapy has the potential to expose patients to vertebral artery damage that can be avoided with the use of mobilization (nonthrust passive movements).
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