by Crystal Phend, Senior Staff Writer, MedPage Today
August 08, 2014
Patients should be warned before chiropractic manipulation of the neck that the technique has been linked to cervical dissection, which can cause stroke, the American Heart Association warned.
A scientific statement from the organization in the October issue of Stroke cautioned about the low level of evidence for a connection.
“Although the incidence of cervical dissection in cervical manipulative therapy patients is probably low, and causality difficult to prove, practitioners should both strongly consider the possibility of cervical dissection and inform patients of the statistical association between cervical dissection and cervical manipulative therapy, prior to performing manipulation of the cervical spine,” it said.
Most population-controlled studies have suggested an association, but reverse causation was possible, writing chair José Biller, MD, of Loyola University Chicago, and colleagues noted.
Part of the concern is that “patients with vertebral artery dissection commonly present with neck pain, which may not be diagnosed prior to any cervical manipulative therapy,” they wrote.
“Because patients with vertebral artery dissection commonly present with neck pain, it is possible that they seek therapy for this symptom from providers, including cervical manipulative therapy practitioners, and that the vertebral artery dissection occurs spontaneously, implying that the association … is not causal.
It is also plausible that cervical manipulative therapy could exacerbate the symptoms or the vertebral artery dissection and possibly increase the risk of stroke.”
Case reports and other clinical reports suggest that the mechanical forces of the quick or slow thrust often used by healthcare providers such as physical therapists, chiropractors or osteopaths may play a role in the development of cervical dissections, although the current biomechanical evidence is insufficient to establish any causal claim, the statement noted.
Patients with neck pain or headache with focal neurological symptoms after any minor trauma, including cervical manipulative therapy, should get immediate medical evaluation for possible stroke from cervical dissection, it recommended.