C.S.I. Reference Articles

Chiropractic Manipulation of the Neck - Is There a Risk?

If you ask a Chiropractor or a Neurologist this question, you may get a different response. Ask a Chiropractor what the risk of a stroke following a cervical manipulation the answer will be close to 1 in every 0.2 million adjustments where as the medical literature has the risk at about 1 per 500,000 adjustments. Why the difference? In an effort to examine the role of bias in these estimates, Scott Haldeman, D.C., M.D., Ph.D et all, studied the perceived incidence of vertebral artery dissection (VAD) from both the Chiropractic and Neurologist points of view and printed the results in The Spine Journal in September 2002.

Examination of the database of the Canadian Chiropractic Protective Association for the period of 1988 to 1997 found 23 cases of VAD. Records from the reported VAD cases indicate 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 shows that these 23 VAD patients saw a total of 216 M.D.’s including 69 Neurologists.

The Researches concluded that “the differences in the number of chiropractors…and neurologists …in active practice and the fact that each patient who has a stroke following manipulation will likely be seen by only one Chiropractor but by 3 or more neurologists partly explains the difference in experience and the perception of risk of these two profession. This selection or referral bias is important in shaping the clinical opinions of the various disciplines and distorts discussion on the true incidence of these complications of cervical manipulation”.

It is important to note that this study was not an attempt to define the risk of stroke following manipulation. Rather it is an examination of the differences in perception. To put things into perspective, the risk of having a serious complication with an over counter drug is 1 in 150,000.