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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Citation Type

Cervical manipulation and cerebrovascular ischemia. A rare but dangerous association. Monocentric experience in a high CEA volume center and literature review.
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  • 2020
TLDR
Manipulations of the neck and cervical spine can rarely cause or contribute to worsening neurological symptoms, however they should always be considered.
Assessing the risk of stroke from neck manipulation: a systematic review
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A systematic review aims to determine whether conclusive evidence of a strong association between neck manipulation and stroke exists, and finds two relevant studies of association that used controls.
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This is the first reported case in which a common surgical position causes an internal carotid artery dissection in a patient without relevant risk factors, and the presentation with Pourfour du Petit syndrome is extremely unusual.
A replication of the study ‘Adverse effects of spinal manipulation: a systematic review’
  • P. Tuchin
  • Medicine
    Chiropractic & Manual Therapies
  • 2012
TLDR
Assessment of the significance of adverse events after spinal manipulation therapy (SMT) by replicating and critically reviewing a paper commonly cited when reviewing adverse events as reported by Ernst found numerous errors or inconsistencies.
POTENTIAL VASCULAR COMPLICATIONS OF CHIROPRACTIC CERVICAL MANIPULATIONS: A REVIEW
Chiropractic is a system of complementary medicine based on the diagnosis and manipulative treatment of misalignments of the joints, especially those of the spinal column. During the last decade, the…
Safety of Chiropractic Spinal Manipulations: With a Review
TLDR
The aim of this review is to investigate the risk of serious complications of chirporactic spinal manipulations to enlighten further understanding on their prevention.
Deaths after Chiropractic: A Review of Published Cases
and Introduction Abstract Objective: The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death. Design: This study is a systematic review of…
Chiropractic and stroke: association or causation?
  • P. Tuchin
  • Medicine
    International journal of clinical practice
  • 2013
TLDR
This article had three lines of text describing the clinical background of this case, which makes it more likely that an important clinical fact was overlooked (such as trauma causing the SDH) and it is impossible to imagine what mechanism could cause a SDH after a neck manipulation.
Should we abandon cervical spine manipulation for mechanical neck pain? Yes
TLDR
It is argued that the risks of cervical spine manipulation are not justified, but David Cassidy and colleagues think it is a valuable addition to patient care.
Tissue Damage Markers after a Spinal Manipulation in Healthy Subjects: A Preliminary Report of a Randomized Controlled Trial
TLDR
The data suggest that the mechanical strain produced by SM seems to be innocuous to the joints and surrounding tissues in healthy subjects, and the presence of tissue damage associated with SM is explored through damage markers analysis.
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References

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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.
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…
Complications of cervical manipulation: a case report of fatal brainstem infarct with review of the mechanisms and predisposing factors.
TLDR
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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TLDR
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.
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.
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TLDR
The possible indication of the prodrome to a stroke may lie in the case history rather than the examination findings and provocative testing.
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TLDR
Three cases of serious neurological adverse events in patients treated with chiropractic manipulation are reported and the described serious adverse events promptly recommend the implementation of a risk alert system.
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TLDR
A population-based nested case-control study to test the association between vertebrobasilar accidents and neck manipulation in young adults and results are consistent with a positive association.
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TLDR
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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TLDR
Autopsy examination of the intracranial and extracranial portions of the vertebral arteries in the case presented here clearly demonstrates that intramural hematoma arising within granulation tissue in the tunica media was the acute, occlusive event.
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