Chiropractic manipulation of the cervical spine, or neck, can cause dizziness, headache, vertigo and lead to stroke. Compression of the cervical arteries is a major concern and is not often disclosed to the patient before treatment in order to prevent increased anxiety levels and potential refusal of chiropractic care. When receiving neck adjustments by a chiropractor, you should always inquire about potential risks associated with the treatment.
Cervical Artery Dissection
Cervical artery dissection, or CAD, describes the separation of vessel wall layers of the carotid or vertebral arteries in the neck, or cervical spine. This condition is the most common cause of stroke in young people and is characterized by neck pain, headache and vision loss. An article in the June 2010 issue of "The Open Neurology Journal" lists major head and neck trauma due to automobile accidents and chiropractic maneuvers as the two most important risk factors for CAD. The authors further described emerging risk factors for this condition and stated that the cause of CAD is not fully understood and requires further investigation.
Vertebrobasilar, or VBA, stroke is a disorder caused by reduced blood flow through the arterial system in the neck. VBA stroke can be brought on by compression of the external wall of the carotid or vertebral arteries due to chiropractic adjustments of the neck. A study in the March 2010 issue of "Spine" investigated the correlation between chiropractic care and VBA stroke in patients admitted to an Ontario, Canada, hospital between 1993 and 2002. Researchers identified 818 VBA strokes and found that patients younger than 45 years were three times more likely to have seen a chiropractor before the onset of stroke, compared to those over 45. However, they did not find evidence of an increased risk of VBA stroke associated with chiropractic care compared to primary care by a physician.
According to an article in the October 2007 issue of "Spine," the risks of adverse effects of chiropractic manipulation of the cervical spine are unknown. Researchers reviewed treatment outcomes of over 19,000 patients and found no reports of serious adverse effects. However, the study did note minor side effects including fainting, dizziness and headache in approximately 15 per 1,000 adjustments. The authors concluded that chiropractic adjustment of the cervical spine was relatively safe.
Disclosure by Chiropractors
A study in the October 2010 issue of "Chiropractic & Osteopathy" investigated the frequency of risk disclosure by chiropractors and consequent withdrawal from treatment as a result. Researchers distributed questionnaires to 200 chiropractors in the U.K. and found that 88 percent of the respondents considered the disclosure of treatment risk to be important when obtaining consent for treatment. However, the researchers noted that only 45 percent of the practitioners admitted that they always discuss the risks of cervical manipulation with their patients. Additionally, 46 percent of the chiropractors admitted that disclosure of possible complications would increase the anxiety levels of their patients to a point where they might refuse treatment.
Is This an Emergency?
- “Chiropractic & Osteopathy”; Withdrawal Rates as a Consequence of Disclosure of Risk Associated with Manipulation of the Cervical Spine; J. Langworthy; October 2010
- “Spine”; Safety of Chiropractic Manipulation of the Cervical Spine: A Prospective National Survey; H. Theil, et al.; October 2007
- “Spine”; Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study; J. Cassidy, et al.; March 2010
- “The Open Neurology Journal”; Cervical Artery Dissection: Emerging Risk Factors; S. Micheli, et al.; June 2010