Vascular accidents after neck manipulation: cause or coincidence?

@article{Ernst2010VascularAA,
  title={Vascular accidents after neck manipulation: cause or coincidence?},
  author={E. Ernst},
  journal={International Journal of Clinical Practice},
  year={2010},
  volume={64}
}
  • E. Ernst
  • Published 1 May 2010
  • Medicine
  • International Journal of Clinical Practice
The statistician Austin Bradford Hill (1897–1991) is credited with listing the minimal conditions which are required for establishing that an association (e.g. manipulation and stroke) is causal by nature (e.g. manipulation causes stroke) (9). His nine criteria are well established and form the basis for evaluating causality in many areas of research. In the following, I will apply them to the question whether vascular accidents after neck manipulation are cause or coincidence. 
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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.
Abrupt Change in Head Position and Cerebral Infarction
Eight patients are described who developed infarctions in the rertebral-basilar artery distribution following chiropractic neck manipulation or spontaneous head turning. The angiographic and autopsy
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This case report should alert the forensic pathologist to the possibility of cervical manipulation as a cause of acute brainstem infarction, and the mechanism and the predisposing factors to injury should be reviewed.
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It is concluded that serious cerebrovascular complications of spinal manipulation continue to be reported and large and rigorous prospective studies are necessary in order to define the risks of spinal manipulative therapies accurately.
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TLDR
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TLDR
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It is suggested that stroke, particularly vertebrobasilar dissection, should be considered a random and unpredictable complication of any neck movement including cervical manipulation.
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