Depuis déjà plusieurs années, un groupe bien organisé tente de faire croire à la population qu'il est extrêmement dangereux de se faire manipuler la colonne cervicale par un chiropraticien. Sachez que cette campagne de propagande ne sert qu'à ce groupe de détracteur, afin de discréditer la chiropratique en utilisant la peur, alors que toutes les études sérieuses démontrent, hors de tout doute, que la chiropratique est au contraire très sécuritaire.
Veuillez consulter cette bande vidéo afin de connaître les faits concernant la sécurité des ajustements faits par un chiropraticien.
Chiropractic safety- let's see the science!
Does Chiropractic Work? Check the science!!
Chiropractic Education-Get the Facts!
Voir tous les articles concernant la sécurité des ajustements du cou ici
Beauty Parlor Stroke Syndrome
If you think chiropractic adjustments can cause stroke, please review this series of abstracts. Extension and rotational stressors, on an already–diseased Vertebral Artery, is the real culprit. There has been less reporting of “Beauty Parlor Stroke” than there has been for chiropractic–related strokes, but it is likely it occurs much more frequently.
Bow Hunter's Stroke
Another instance of extension and rotational stresses leading to stroke.
Stroke & Essential Fatty Acids
Stroke is the third leading cause of death in the US. Fortunately, diagnostic imaging for stroke risk and stroke-prevention strategies have advanced greatly in recent years. It is now possible to reduce the artery-clogging plaque that leads to stroke, offering hope that this debilitating condition can be prevented.
Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-based Case-control and Case-crossover Study
Spine 2008 (Feb 15); 33 (4 Suppl): S176–183
VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.
Cervical Spine Adjusting and the Vertebral Artery
Association of Chiropractic Colleges
Thanks to the Association of Chiropractic Colleges and Gerard Clum, D.C., President of Life Chiropractic College West, for supplying us with these 73 educational slides for your review.
Putting Risk into Perspective
ACAnews ~ September 2007
Over the last three years, doctors of chiropractic in the state of Connecticut have been subject to a rash of anti-chiropractic advertisements conspicuously placed on rolling and static billboards, and in well-read statewide newspapers. Most recently, doctors saw a spate of unprecedented anti-chiropractic legislation aimed to mandate informed consent in chiropractic offices and require open access to chiropractic malpractice records.
The Benefits Outweigh the Risks for Patients Undergoing Chiropractic Care for Neck Pain: A Prospective, Multicenter, Cohort Study
J Manipulative Physiol Ther 2007 (Jul); 30 (6): 408–418
In contrast to clinical trials of prescription medication, researchers in the area of conservative care for musculoskeletal complaints have focused their attention on treatment effectiveness and, to a much lesser degree, on adverse events. This study, consisting of patients treated in a wide variety of chiropractic practices and settings, describes both positive and negative, and short- and long-term clinical outcomes for a relatively large study population with neck pain. Although many of the subjects (in this study) had chronic, recurrent neck pain and had undergone prior care for this complaint, many patients experienced benefit from the treatment (based upon diminished pain and disability, the percentage of patients recovered and percentage satisfied with care). Furthermore, many responded relatively quickly to treatment (48% were recovered at the fourth visit).
Inappropriate Use of the title Chiropractor and term Chiropractic Manipulation in the Peer-reviewed Biomedical Literature
Chiropractic & Osteopathy 2006 (Aug 22); 14 (1): 16
The results of this year-long prospective review suggests that the words chiropractor and chiropractic manipulation are often used inappropriately by European biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury. Furthermore, in those cases reported here, the spurious use of terminology seems to have passed through the peer-review process without correction. Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title chiropractor and term chiropractic manipulation may be a significant source of over-reporting of the link between the care provided by chiropractors and injury.
Are German Orthopedic Surgeons Killing People With Chiropractic?
Journal of Neurology 2006 (Mar 6)
Editorial Commentary: I present for your review an abstract from the Journal of Neurology. This abstract blatantly conceals the facts stated in the body of the paper when it states that “we describe 36 patients with vertebral artery dissections and prior chiropractic neck manipulation”. When I read that sentence, I am led to believe that “real-live chiropractors” (meaning licensed Doctors of Chiropractic, who received their training at a CCE/WCCE accredited schools) were the ones to provide the “chiropractic neck manipulation”. Unfortunately, that couldn't be further from the truth!
Cerebrovascular Accident Without Chiropractic Manipulation: A Case Report
J Manipulative Physiol Ther 2006 (May); 29 (4): 330–335
A 49-year-old man with non-traumatic chronic episodic head and neck pain presented for care. Examination and plain film radiographs were unremarkable, suggesting a mechanical origin for the symptoms; however, information in the case history raised concerns. The patient was examined and not manipulated by the doctor of chiropractic but referred back to his general practitioner for a second opinion. The following week, the patient was admitted to hospital having had a cerebrovascular accident. The possible indication of the prodrome to a stroke may lie in the case history rather than the examination findings and provocative testing.
Current Concepts: Spinal Manipulation and Cervical Arterial Incidents 2005
NCMIC ~ Executive Summary (8 pages)
There is a growing concern and awareness of an association between chiropractic manipulation and cerebrovascular accidents (CVAs). Unfortunately, opinion rather than fact has tended to dominate discussions regarding CVAs and chiropractic, even though there has been no definitive evidence that chiropractic adjustments (actually) cause strokes. The good news is that this monograph notes that a causative relationship between chiropractic manipulation and stroke is unlikely. There is an associative relationship between the two because people may go to chiropractors for relief of stroke-related symptoms.
Cerebrovascular Accidents: The Rest of The Story
Anthony L. Rosner, PhD., Research Director for FCER
During the past decade, the issues of cerebrovascular accidents [CVAs] and spinal manipulation have become linked in a debate of ever-increasing intensity. A copious number of studies have investigated spinal manipulation as a putative causative factor of CVAs; however, a common theme among these is the failure to adequately explore the possibility that the majority of CVAs may be spontaneous, cumulative, or caused by factors ther than spinal manipulation itself. The problem is only exacerbated by the sometimes hysterical reactions apparent in the mass media over the past three years in reaction to the flawed investigations. This paper was presented Friday June 20, 2003 at the International Spinal Trauma Conference in Chicago, IL. Thanks to Dr. Rosner and the FCER for permission to reproduce this FULL TEXT article exclusively at Chiro.Org!
The Stroke Issue: Paucity of Valid Data, Plethora of Unsubstantiated Conjecture
J Manipulative Physiol Ther 2004 (June); 27 (5): 368–372
Chiropractic can be proud of its exemplary standards in the areas of informed consent and the allocation of funding for research to study issues of safety. As a responsible, ethical, and caring profession, chiropractic must continue to look into the issue regarding the potential risk of chiropractic adjustment. At this time, it cannot be scientifically stated that there is no risk of VBA dissection from chiropractic cervical adjustment. It can, and in my opinion must, be scientifically stated that there is neither valid evidence of a causal relationship between chiropractic cervical adjustment and VBA dissection nor any valid data to estimate a risk of VBA dissection associated with chiropractic cervical adjustment. It can also be stated that the data that are available regarding the total number of adjustments performed each year, the total number of VBA dissections and occlusions that occur in the absence of chiropractic adjustment each year, and the data that indicate a chiropractic cervical adjustment represents less force to the vertebral artery than movement within the normal range of motion make it more logical to assume a temporal rather than causal link between these 2 events.
A Risk Assessment of Cervical Manipulation vs. NSAIDs for the Treatment of Neck Pain
J Manipulative Physiol Ther 1995 (Oct); 18 (8): 530–536
As for comparative safety, the best available evidence indicates that NSAID use poses a significantly greater risk of serious complications and death than the use of cervical manipulation for comparable conditions. In conclusion, the best evidence indicates that cervical manipulation for neck pain is much safer than the use of NSAIDs, by as much as a factor of several hundred times. There is no evidence that indicates NSAID use is any more effective than cervical manipulation for neck pain.
Efficacy and Risks of Chiropractic Manipulation: What Does the Evidence Suggest?
Integrative Medicine 1998; 1: 61-66
This review article drew upon the appropriateness studies conducted at RAND, which indicated efficacy of manipulation for acute or sub-acute low back pain, neck pain, and muscle-tension-type headaches. The article also reported the low risk of serious complications from lumbar and cervical manipulations. According to the literature review, the estimated risk for serious complications from cervical manipulation is 6.39 per 10 million manipulations. For lumbar manipulation, it is 1 per 100 million manipulations. These estimates compare favorably to other forms of therapy, such as cervical spine surgery or nonsteroidal anti-inflammatory drugs (NSAIDS). The risk from manipulation is low and compares favorably to other forms of therapy for the same conditions (e.g., 15.6 complications per 1000 cervical spine surgeries, 3.2 per 1000 subjects for nonsteroidal anti-inflammatory drugs)
Is Cervical Spinal Manipulation Dangerous?
J Manipulative Physiol Ther 2002 (Oct); 25 (8): 504-510
It appears that the risk of cerebrovascular accidents after cervical manipulation is low, considering the enormous number of treatments given each year, and very much lower than the risk of serious complications associated with generally accepted surgery. Provided there is a solid indication for cervical manipulation, we believe that the risk involved is acceptably low and that the fear of serious complications is greatly exaggerated.
Is It Time To Stop Functional Pre-manipulation Testing of the Cervical Spine?
Manual Therapy 2005 (May); 10 (2): 154-158
The combined extended and rotated cervical spine position has been postulated to affect vertebral artery blood flow by primarily causing a narrowing of the vessel lumen, usually within the artery contralateral to the side of head rotation. The production of brainstem symptoms during the manoeuvre has generally been considered to be a positive test result. As a consequence, functional pre-manipulation testing of the cervical spine has been part of clinical screening undertaken by chiropractors and other manual practitioners to rule out the risk of possible injury to the vertebral artery.
Defining the Effect of Cervical Manipulation on Vertebral Artery Integrity: Establishment of an Animal Model
J Manipulative Physiol Ther 2004 (Nov); 27 (9): 539–546
Over the past 5 to 10 years, the issue of cerebrovascular accidents (CVAs) and spinal manipulation has become a debate of ever-increasing intensity. A copious number of studies have investigated spinal manipulation as a putatative causative factor of CVAs [ 1-5 ]; however, a common theme among these is the failure to consider that the majority of vertebrobasilar accidents (VBAs) may be spontaneous, cumulative, or caused by factors other than spinal manipulation. The problem is not served by the sometimes hysterical reactions apparent in the media over the past 2 years in reaction to the flawed investigations.[ 6-11 ] In light of these recent reports, the entire phenomenon of spontaneous cervical artery dissections should be revisited to put this matter into a better perspective.
Association of Internal Carotid Artery Dissection and Chiropractic Manipulation
Neurologist 2003 (Jan); 9 (1): 35–44
In reviewing the cases of internal carotid dissection potentially related to CMT, there were many confounding factors, such as connective tissue aberrations, underlying arteriopathy, or coexistent infection, that obscured any obvious cause-and-effect relationship. To date there are only 13 reported cases of ICAD temporally related to CMT. Most ICADs seem to occur spontaneously and progress from local symptoms of headache and neck pain to cortical ischemic signs. Approximately one third of the reported cases were manipulated by practitioners other than chiropractic physicians, and because of the differential risk related to major differences in training and practice between practitioners who manipulate the spine, it would be inappropriate to compare adverse outcomes between practitioner groups.
Scientific Evidence Over-Rides the False Claims in Canadian Stroke Case
Joel Alcantara, D.C., Director of Research for the ICPA
The Lana Lewis inquest in Canada is well known to Canadian chiropractors as it has and will affect the practice of chiropractic in that country and possibly the world. The following is a summary from one of the expert witnesses called by the chiropractic profession, Dr. David Sackett. To some, the name may be familiar, particularly since its synonymous with the words “evidenced-based medicine”.
Spontaneous Cervical Artery Dissections and Implications for Homocysteine
J Manipulative Physiol Ther 2004 (Feb); 27 (2): 124–132
As shown in Table 1, the annual incidence of spontaneous VADs in hospital settings has been estimated to occur at the rate of 1 to 1.5 per 100,000 patients. [ 15 ] The corresponding VAD incidence rate in community settings has been reported to be twice as high. [ 16,17 ] Using an estimated value of 10 from the literature to represent an average number of manipulations per patient per episode, [ 23 ] it becomes apparent that the proposed exposure rate for CVAs attributed to spinal manipulation is equivalent to the spontaneous rates for cervical arterial dissections as reported. [ 15-17 ] If the threat of stroke or stroke-like symptoms is to be properly assessed, therefore, at least half our attention needs to be directed toward the spontaneous events instead of primarily or solely on spinal manipulation.
Cervical Artery Dissection A Comparison of Highly Dynamic Mechanisms: Manipulation Versus Motor Vehicle Collision
J Manipulative Physiol Ther 2005 (Jan); 28 (1): 57–63
This recent review of the literature finds: “Additionally, long-lasting abnormalities of blood flow velocity within the vertebral artery have been reported in patients following common whiplash injuries, whereas no significant changes in vertebral artery peak flow velocity were observed following cervical chiropractic manipulative therapy”. and concludes that: “The direct evidence suggests that the healthy vertebral artery is not at risk from properly performed chiropractic manipulative procedures”.
Vertebrobasilar Ischemia and Spinal Manipulation
J Manipulative Physiol Ther 2003 (Sep); 26 (7): 443–447
This pratitioner examine(d) cerebral arterial blood flow in 2 patients exhibiting signs of vertebrobasilar arterial ischemia (VBI) before and after spinal manipulative therapy. Improvements in arterial flow following spinal adjusting led the author to surmise: “Spinal manipulation may have a normalizing effect on the sympathetic nervous system, allowing for a change in vasospastic cerebral vascular arteries”.
Motor Vehicle Accidents: The Most Common Cause of Traumatic Vertebrobasilar Ischemia
Can J Neurol Sci 2003 (Nov); 30 (4): 320–325
There were 80 patients whose vertebrobasilar ischemia was attributed to neck trauma. Five were diagnosed as due to chiropractic manipulation, but the commonest attributed cause was motor vehicle accidents (MVAs), which accounted for 70 cases; one was a sports injury, and five were industrial accidents. In some cases neck pain from an MVA led to chiropractic manipulation, so the cause may have been compounded. In most vehicular cases the diagnosis had been missed, even denied, by the neurologists and neurosurgeons initially involved. The longest delay between the injury and the onset of delayed symptoms was five years.
Clinical Perceptions of the Risk of Vertebral Artery Dissection After Cervical Manipulation: The Effect of Referral Bias
Spine J 2002 (Sep); 2 (5): 334–342
For the 10-year period 1988 to 1997, there were 23 cases of vertebral artery dissection after cervical manipulation reported to the CCPA that represents 85% of practicing chiropractors in Canada. Based on the survey, an estimated 134,466,765 cervical manipulations were performed during this 10-year period. This gave a calculated rate of vertebral artery dissection after manipulation of 1:5,846,381 cervical manipulations. Based on the number of practicing chiropractors and neurologists during the period of this study, 1 of every 48 chiropractors and one of every two neurologists would have been made aware of a vascular complication from cervical manipulation that was reported to the CCPA during their practice lifetime.
The Validity of the Extension-rotation Test as a Clinical Screening Procedure Before Neck Manipulation: A Secondary Analysis
J Manipulative Physiol Ther 1996 (Mar); 19 (3): 159–164
We were unable to demonstrate that the extension-rotation test is a valid clinical screening procedure to detect decreased blood flow in the vertebral artery. The value of this test for screening patients at risk of stroke after cervical manipulation is questionable.
Response to Vertebral Artery Dissection Study: Synopsis Paper by Smith et al. Published in May 13, 2003 Issue of Neurology
FCER ~ May 18, 2003
The recent publication by Smith et al. in Neurology addressing vertebral artery dissection represents another episode of regrettable studies which, despite serious flaws which raise substantial questions as to their internal validity, go at great lengths to selectively disparage the advisability of performing cervical manipulations as a means of patient care while obscuring the larger picture.
Perspectives: An Overview of Comparative Considerations of Cerebrovascular Accidents
Chiropractic Journal of Australia 1999; 29 (3): 87—102
This paper seeks to contrast reports concerning major adverse side effects, viz. cerebrovascular accidents (CVAs) attributed to cervical spine manipulation, within a broad perspective of medical procedures. It also seeks to correlate the incidence rates of other adverse events and medical procedures with the general incidence rate of CVAs. On analysis, an accurate position would indicate that cervical spinal manipulation is one of the more conservative, least invasive and safest of procedures in the provision of human health care services. The paper also alludes to the political connotations on the subject. Thanks to the Chiropractic Journal of Australia for permission to reproduce this FULL TEXT article exclusively at Chiro.Org!
Unpredictability of Cerebrovascular Ischemia Associated with Cervical Spine Manipulation Therapy: A Review of Sixty-four Cases After Cervical Spine Manipulation
Spine 2002 (Jan 1); 27 (1): 49–55
This study was unable to identify factors from the clinical history and physical examination of the patient that would assist a physician attempting to isolate the patient at risk of cerebral ischemia after cervical manipulation. Cerebrovascular accidents after manipulation appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach.
Vertebral Arteries and Cervical Rotation: Modeling and Magnetic Resonance Angiography Studies
J Manipulative Physiol Ther 2002 (Jul); 25 (6): 370-383
All 16 vertebral arteries from the 8 patients displayed no changes in their lumen dimensions with full cervical rotation, although curves in each of the arteries did change. The model and cadaveric vertebral arteries demonstrated localized compression or kinking of the vessel wall with atlanto-axial rotation contralaterally but revealed no evidence of major contribution of stretching to stenosis.
Manipulation of the Neck and Stroke: Time for More Rigorous Evidence
Med J Aust 2002 (Apr 15); 176 (8): 376-380
In this issue of the Journal, Ernst reviews case reports of serious adverse events associated with cervical spine manipulation. Although Ernst acknowledges the considerable doubt about a causal relationship between the manipulation and the adverse event, he is inconsistent in suggesting that the anecdotal and uncontrolled evidence of the case reports favours the adverse events, often strokes, being an effect of manipulation. Elucidating a causal relationship calls for greater clarity, less ambivalence and generally better science in the present evidence-based climate. Thus, the important question to be answered in the light of Ernst's article is whether the association between neck manipulation and stroke is actually causal and, if so, in what direction?
VAD Following Cervical Manipulation: D.C. vs M.D. Experiences Affect Perception of Risk
FCER ~ January 13, 2003
Examination of the database of the Canadian Chiropractic Protective Association (CCPA, which provides malpractice insurance for 85% of chiropractors in Canada) for the period 1988 to 1997 found 23 cases of VAD. Retrospective review of these cases and a survey of chiropractors suggests an estimated 134,466,765 cervical manipulations were performed during the 10-year period. Records from these reported VAD cases indicates that in a 30 year practice, only one in 48 chiropractors would be aware of a vascular incident following cervical manipulation. In contrast, examination of the records show that these 23 VAD patients saw a total of 216 physicians, including 69 neurologists.
The Benefits and Risks of Spinal Manipulation
Paul G. Shekelle, MD, PhD; Reed B. Phillips, DC, PhD; Daniel C. Cherkin, PhD; William C. Meeker, DC, MPH
This chapter summarizes what has been learned from clinical trials about the benefits of spinal manipulation for specific problems and from case reports about the risks of spinal manipulation. In addition, findings of studies examining the ability of spinal manipulation to increase patient satisfaction, decrease cost, or increase cost-effectiveness of care are summarized. This is the 11th chapter of “Chiropractic in the United States: Training, Practice, and Research”, a publication (Dec 1997) by the Agency for Health Care Policy and Research (AHCPR).
Chiropractic Manipulation and Stroke
Stroke 2001 (Sep); 32 (9): 2207—2208
This is the response to the Rothwell et al. article (Stroke 2001;32:1054) by Anthony Rosner, PhD of the FCER.
Internal Forces Sustained by the Vertebral Artery During Spinal Manipulative Therapy
J Manipulative Physiol Ther 2002 (Oct); 25 (8): 504–510
SMT resulted in strains to the VA that were almost an order of magnitude lower than the strains required to mechanically disrupt it. We conclude that under normal circumstances, a single typical (high-velocity/low-amplitude) SMT thrust is very unlikely to mechanically disrupt the VA.
Uneventful Upper Cervical Manipulation in the Presence of a Damaged Vertebral Artery
J Manipulative Physiol Ther 2002 (Sept); 25 (7): 472–483
This case report demonstrates that vigorous manipulation of the upper cervical spine is possible without injuring an already damaged vertebral artery. It is suggested that the line of drive used during the single manipulation, almost pure lateral flexion with slight rotation, was responsible for the apparent innocuous response. Guidelines for the evaluation and management of vertebral artery dissection are reviewed. Because it is currently impossible to identify patients at risk of having a dissected vertebral artery with standard in-office examination procedures, rotational manipulation of the upper cervical spine should be abandoned by all practitioners, and schools should remove such techniques from their curriculums.
Stroke, Cerebral Artery Dissection, and Cervical Spine Manipulation Therapy
Journal of Neurology 2002 (Jul); 249 (8): 1098–1104
Stroke represents an infrequent adverse reaction associated with cervical spine manipulation therapy. Attempts to identify the patient at risk and the type of manipulation most likely to result in these complications of manipulation have not been successful. A retrospective review of 64 medical legal cases of stroke temporally associated with cervical spine manipulation was performed to evaluate characteristics of the treatment rendered and the presenting complaints in patients reporting these complications. Ninety two percent of cases presented with a history of head and/or neck pain and 16 (25 %) cases presented with sudden onset of new and unusual headache and neck pain often associated with other neurological symptoms that may represent a dissection in progress. The strokes occurred at any point during the course of treatment. Certain patients reporting onset of symptoms immediately after first treatment while in others the dissection occurred after multiple manipulations. There was no apparent dose-response relationship to these complications.
International Expert Debunks Stroke Consortium Chief's Claims About Link Between Stroke and Neck Adjustment
Canada Newswire; Nov 18, 2002
TORONTO, Nov 18, 2002 (Canada NewsWire via COMTEX) -- A leading world expert on scientific methodology and research, Dr. David Sackett, an officer of the Order of Canada and member of the Canadian Medical Hall of Fame, today described Dr. John Norris, former Chair of the Canadian Stroke Consortium, as “incompetent” in scientific research and “irresponsible” with regard to the Consortium's work attributing strokes to neck adjustment.
Transcranial Sonography and Vertebrobasilar Insufficiency
J Manipulative Physiol Ther 2002 (Mar); 25 (3): 180-183
This illustrates a case of extra-arterial mechanical compression of the vertebral arteries documented by transcranial Doppler sonography procedures. Brainstem symptoms were correlated with a documented perfusion deficit during cervical positional testing. This case also demonstrated that spinal manipulative therapy may be safely used on patients with vertebrobasilar insufficiency when the biomechanics and related flow studies are elucidated.
Arterial Dissections Following Cervical Manipulation: The Chiropractic Experience
Canadian Medical Association Journal 2001 ( Oct 2); 165 (7): 905–906
Following approval by the Institutional Review Board of the Canadian Memorial Chiropractic College in Toronto, Ont., a review of malpractice data from the Canadian Chiropractic Protective Association (CCPA) was carried out to evaluate all claims of stroke following chiropractic care for the 10-year period between 1988 and 1997. There are over 4500 licensed chiropractors in Canada. The likelihood that a chiropractor will be made aware of an arterial dissection following cervical manipulation is approximately 1:8.06 million office visits, 1:5.85 million cervical manipulations, 1:1430 chiropractic practice years and 1:48 chiropractic practice careers.
Sudden Neck Movement and Cervical Artery Dissection
Canadian Medical Association Journal 2000 (Jul 11); 163: 38–40
During the past year the Canadian Stroke Consortium, a national network of stroke physicians, has been prospectively collecting detailed information on cases of dissection of the cervical arteries. Seventy-four patients have been studied so far: their age range was 16-87 years (mean 44 years), 60% were male, and there was a predominance of vertebrobasilar artery dissections compared with carotid artery dissections (72% v. 28%). Most (81%) of the dissections were associated with sudden neck movement, ranging from therapeutic neck manipulation to a vigorous game of volleyball, but some occurred during mild exertion such as lifting a pet dog or during a bout of coughing.
New Study Puts Stroke From Neck Adjustment at Less than 1 in 5 Million Adjustments
Toronto, October 12, 2001— A new Canadian study, reported in the October 2, 2001 issue of the Canadian Medical Association Journal (CMAJ), puts the risk of stroke following neck adjustment at 1 in every 5.85 million adjustments. The study, which is based on patient medical files and malpractice data from the Canadian Chiropractic Protective Association, evaluated all claims of stroke following chiropractic care for a ten year period between 1988 and 1997.
A Review of the Significant Shortcomings in the Reporting of Stroke Associated with Cervical Manipulation
Clinical Practice Guidelines, Chapter 9: Patient Safety
In the case of strokes purportedly associated with manipulation, the panel noted significant shortcomings in the literature. A summary of the relevant literature follows. For example: “In a letter to the editor of the Journal of Manipulative and Physiological Therapeutics, Myler(9) wrote, I was curious how the risk of fatal stroke after cervical manipulation, placed at 0.00025%(10) compared with the risk of (fatal) stroke in the general population of the United States. According to data obtained from the National Center for Health Statistics, the mortality rate from stroke in the general population was calculated to be 0.00057%. If these data are correct, the risk of a fatal stroke following cervical manipulation is less than half the risk of fatal stroke in the general population.”
Risk Assessment of Neurological and/or Vertebrobasilar Complications in the Pediatric Chiropractic Patient
Journal of Vertebral Subluxation Research (JVSR) 1998; 2 (2): 73–78
The estimate of risk due to the pediatric chiropractic patient in this category of complication was estimated to be 4.0 x 10 -7 % of all visits. Stated otherwise, there would be a chance of approximately 1 in 250 million pediatric visits that a N/VB complication would result. While some pre-existing conditions may predispose a pediatric patient to a higher incidence of such complications, the estimates derived in the present study are considered applicable to the general pediatric population.
Letter to the Editor, The New York Times, regarding the Jane Brody article of April 3, 2001
Anthony L. Rosner, Ph.D.
Jane Brody's recent article [“When Simple Actions Ravage Arteries”, 04/03/01] is an unfortunate and careless portrayal of a healthcare intervention which was specifically designed to avoid the more serious and often irreversible sequelae of the more invasive tools of orthodox medicine: drugs and surgery. Emphasizing the body's own capacity to heal, chiropractic management of patients is based upon the diagnosis, treatment and prevention of disorders of the musculoskeletal system and how they are reflected upon general health through the nervous system.
What are the Risk of Chiropractic Neck Treatments?
William J. Lauretti, DC
Every published study which has estimated the incidence of stroke (CVA) from cervical manipulation has agreed that the risk is 1 to 3 incidents per million treatments. Dvorak, [ 1 ] in a survey of 203 practitioners of manual medicine in Switzerland, found a rate of one serious complication per 400,000 cervical manipulations, without any reported deaths, among an estimated 1.5 million cervical manipulations. Jaskoviak [ 2 ] reported approximately 5 million cervical manipulations from 1965 to 1980 at The National College of Chiropractic Clinic in Chicago, without a single case of vertebral artery stroke or serious injury.
Manipulation and Mobilization of the Cervical Spine. A Systematic Review of the Literature
Spine 1996 (Aug 1); 21 (15): 1746–1760
The combination of three of the randomized controlled trials comparing spinal manipulation with other therapies for patients with subacute or chronic neck pain showed an improvement on a 100-mm visual analogue scale of pain at 3 weeks of 12.6 mm (95% confidence interval, -0.15, 25.5) for manipulation compared with muscle relaxants or usual medical care. The highest quality randomized controlled trial demonstrated that spinal manipulation provided short-term relief for patients with tension-type headache. The complication rate for cervical spine manipulation is estimated to be between 5 and 10 per 10 million manipulations.
Response to Vertebral Artery Dissection Study: Canadian Journal of Neurological Sciences
Anthony L. Rosner, Ph.D.
A recent publication addressing vertebral artery dissection in The Canadian Journal of Neurological Sciences [ 1 ] is surprisingly anecdotal and sketchy in its depiction of both the possible causes and etiology of the subject it is intended to discuss. As such, it is laden with severe methodological deficiencies which severely undercut its credibility and create misleading impressions of vertebral artery dissection and raise more fundamental questions as to how retrospective studies should be conducted. There are at least five critical issues which need to be brought into consideration in order to more fully understand this particular study in a broader perspective.
Vertebral Artery Dissection Causing Stroke in Sport
J Clin Neurosci 2000 (Jul); 7 (4): 298–300
Stroke in sport, although uncommon, is predominantly due to arterial dissection in either the vertebral or carotid arteries. Physicians involved in athlete care need to be aware of this diagnosis.
Vertebral Artery Dissection: Warning Symptoms, Clinical Features and Prognosis in 26 Patients
Can J Neurol Sci 2000 (Nov); 27 (4): 292–296
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.
Vertebral Artery Dissection and Migraine Headaches in Children
J Child Neurol 2000 (Oct); 15 (10): 694–696
Risk factors for vertebral artery dissection are reviewed, with emphasis on association with migraine headaches. A review of imaging studies for the diagnosis of dissection is also presented. This case demonstrates the importance of considering arterial wall dissection in pediatric patients with a history of atypical migraines associated with new neurologic findings.
Acupuncture and Stroke Recovery
Johansson et al (1993) investigated the effectiveness of acupuncture as a supplement to physical therapy in recovery from stroke. Pang (1994) investigated two particular scalp acupuncture techniques in order to compare their effectiveness in treating apoplexy following stroke.
Is There a Role for Premanipulative Testing Before Cervical Manipulation?
J Manipulative Physiol Ther 2000 (Mar); 23 (3): 175–179
It appears that a positive premanipulative test is not an absolute contraindication to manipulation of the cervical spine. If the test is able to identify patients at risk for cerebrovascular accidents, we suggest patients with a reproducible positive test should be referred for a duplex examination of the vertebral artery flow. If duplex flow is normal, the patient should be eligible for cervical manipulation despite the positive premanipulative test.
Safety in Chiropractic Practice, Part I: The Occurrence of Cerebrovascular Accidents After Manipulation to the Neck in Denmark from 1978–1988
J Manipulative Physiol Ther 1996 (Jul); 19 (6): 371–377
Although the incidence of CVA after chiropractic SMT was confirmed to be low, there seems to be sufficient evidence to justify a firm policy statement cautioning against upper cervical rotation as a technique of first choice.
Safety in Chiropractic Practice Part II: Treatment to the Upper Neck and the Rate of Cerebrovascular Incidents
J Manipulative Physiol Ther 1996 (Nov); 19 (9): 563–569
Retrospective data were collected from questionnaires covering the period 1978-1988 inclusive; in a second survey, chiropractors provided information obtained through inspection of their own case records.
Misuse of the Literature by Medical Authors in Discussing Spinal Manipulative Therapy Injury
J Manipulative Physiol Ther 1995 (May); 18 (4): 203–210
The words chiropractic and chiropractor have been incorrectly used in numerous publications dealing with SMT injury by medical authors, respected medical journals and medical organizations. In many cases, this is not accidental; the authors had access to original reports that identified the practitioner involved as a non–chiropractor. The true incidence of such reporting cannot be determined. Such reporting adversely affects the reader's opinion of chiropractic and chiropractors.
Tissue Plasminogen Activator in a Vertebral Artery Dissection
Can J. Neurol Sci 1997 (May); 24 (2): 151–154
We report a 49-year-old woman who presented with the rapidly progressing basilar artery syndrome who was given an intravenous dose of tissue plasminogen activator seven hours after the onset of first symptoms. Thirty minutes after the injection, a dramatic recovery of the patient's consciousness and neurological signs was noted.
Vertebral Artery Flow and Cervical Manipulation: An Experimental Study
J Manipulative Physiol Ther 1999 (Sep); 22 (7): 431–435
We present an experimental model for investigations of vertebral artery hemodynamics during biomechanical interventions. We found a modest and transient effect of cervical manipulation on vertebral artery volume flow. The model may have further applications in future biomechanical research, for example, to determine whether any of several spinal manipulative techniques imposes less strain on the vertebral artery, thereby reducing possible future cerebrovascular accidents after such treatment.
Vertebral Artery Flow and Spinal Manipulation: A Randomized, Controlled and Observer Blinded Study
J Manipulative Physiol Ther 1998 (Mar); 21 (3): 141–144
To the best of our knowledge, this is the first study comparing flow velocity in the vertebral artery before and after spinal manipulative therapy. We found no significant changes in otherwise healthy subjects with a biomechanical dysfunction of the cervical spine.
Vertebral Artery Volume Flow in Human Beings
J Manipulative Physiol Ther 1999 (Jul); 22 (6): 363–367
This appears to be the first in vivo Doppler study on human vertebral artery volume blood flow. Our results indicate that in symptom-free subjects there is no change in vertebral artery perfusion during rotation in spite of significant changes in flow velocity.
Effect of Premanipulative Tests on Vertebral Artery and Internal Carotid Artery Blood Flow: A Pilot Study
J Manipulative Physiol Ther 1999 (Jul); 22 (6): 368–375
Screening procedures that use rotation and extension may be useful tests of the adequacy of collateral circulation. A larger study is needed to determine whether subjects testing positive significantly differ from those testing negative.
A Review of the Reported Complications from Spinal Manipulation
John J. Triano, D.C., Ph.D.
In general, chiropractic treatment has little associated risk. Table TX5 displays the complications of spinal manipulation that have been reported [Haldeman, Haldeman, LeBoeuf-Yve]. Nearly all reactions to manipulation are mild and self-limiting, lasting less than 24 hours. Rarely, significant injury can result from injudicious or inappropriate use. The incidence of serious complication is less than 1:1,000,000.
Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation
Spine 1999 (Apr 15); 24 (8): 785–794
The literature does not assist in the identification of the offending mechanical trauma, neck movement, or type of manipulation precipitating vertebrobasilar artery dissection or the identification of the patient at risk. Thus, given the current status of the literature, it is impossible to advise patients or physicians about how to avoid vertebrobasilar artery dissection when considering cervical manipulation or about specific sports or exercises that result in neck movement or trauma.
Claims of Risk From Chiropractic Care For Neck Pain Are Exaggerated Say Experts At The Texas Back Institute
Plano, TX - May 10, 2000 -- Periodic claims posed in the public and professional media that Chiropractic treatment to the neck poses a high risk for stroke are unwarranted say the experts at the Texas Back Institute.
Stroke Prevention Guidelines Issued
“Stroke is... killing about 160,000 Americans each year,” Dr. Ralph Sacco of the departments of neurology and public health at Columbia University in New York told reporters at a telephone press conference on Thursday. “About 700,000 people will have a new or recurrent stroke each year,” he added, “and stroke incidence seems to be on the rise”. To reduce risk of stroke, the NSA offers these basic recommendations. |
