For neurologists, there is a little doubt that chiropractic manipulation can cause vertebral artery dissection, with more than 100 reported cases of posterior. Wed like to understand how you use our websites in order to improve them. Chiropractic care and the risk of vertebrobasilar stroke. S176s183 spine volume 33, number 4s, pp s176s183 doi 10. There is controversy surrounding the risk of manipulation, often used by chiropractors, with association to vertebrobasilar vba stroke. This is a retrospective cohort analysis of a 100% sample of annualized medicare claims data on 1 157 475. The potential risk is serious enough to outweigh the potential benefit. Results of a populationbased casecontrol and casecrossover study spine, volume 33, number 4s, pp s176s183. Palmer chiropractic position paper on adjustments and the risk of vertebrobasilar stroke summary statement it is the position of palmer chiropractic that the vast majority of scientific evidence shows that a patient who receives a specific chiropractic adjustment has a minimal risk of vertebrobasilar stroke.
Does chiropractic care increase the risk of vertebrobasilar. To investigate associations between chiropractic visits and vertebrobasilar artery vba stroke and to contrast this with primary care physician. There is an association between vertebrobasilar artery stroke and chiropractic visits in those under 45 years of age. Annals of medicine weighs in on cervical artery dissection. Risk of vertebrobasilar stroke and chiropractic care europe. Examining vertebrobasilar artery stroke in two canadian.
There is controversy surrounding the risk of manipulation, which is often used by chiropractors, with. 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. Chiropractic care is popular for neck pain and headache, but may increase the risk for vba dissection and stroke. I hope you have enjoyed our blog posts on various health, nutritional and injury related topics. Research results in fact, a recent study that examined data regarding a large group of elderly chiropractic patients with neck pain found that the risk of vbs as a result of cervical adjustment was very low. We found no evidence of excess risk of vba stroke associated chiropractic care. Apr 01, 2008 risk of vertebrobasilar stroke and chiropractic care risk of vertebrobasilar stroke and chiropractic care cassidy, j boyle, eleanor. The increased risks of vba stroke associated with chiropracticand pcp visits is likely due to patients with headache and neck painfrom vba dissection seeking care before their stroke. A large number of publications, from case reports to casecontrol studies, have investigated this relationship. May 20, 2008 recently, i had the pleasure of reading a study by j. Chiropractic care is popular for neck pain and headache, but may increase the.
The most common of these myths is that chiropractic adjustments to the cervical spine can lead to a vertebrobasilar stroke vbs. Risk of vertebrobasilar stroke and chiropractic care ncbi. Please dont hesitate in calling us or myself if you have questions when the need to seek care arises. Probably the most catastrophic risk of manipulation that has been proposed is the risk of vertebrobasilar artery vba dissection or stroke following cervical spine manipulation. Feb 15, 2008 risk of vertebrobasilar stroke and chiropractic care. S176s183 neck pain is a common problem associated with consid.
Research published today has found no significant association between chiropractic visits and vertebrobasilar stroke. In the meantime, chiropractic cervical manipulation cannot be considered risk free, particularly in view of the fact that, as mentioned by the authors, vertebral artery dissection can present with neck pain as the only symptom, thus leading the patient to consult a chiropractor. The purported relationship between cervical manipulative therapy cmt and stroke related to vertebral artery dissection vad has been debated for several decades. The assumption that patients sought care for preexisting symptoms of stroke was not justified by the data. Results from the 2012 national health interview survey risk of vertebrobasilar stroke and chiropractic care. Cervical artery dissection related to chiropractic. Results of a populationbased casecontrol and casecrossover study spine volume 334s, february 15, 2008 pp s176s183. Aug 07, 2014 the chiropractic community is aware of the association between neck manipulation and stroke, which is an issue that has simmered for about five years now, said keith overland, immediate past. Results of a populationbased casecontrol and case crossover study. Aug 28, 2017 equally important, mcdermott says, are regular followups with a health care provider. Cassidy j, boyle e, cote p, he y, hoggjohnson s, silver f, et al.
We found no significant association between exposure to chiropractic care and the risk of vba stroke. We found no evidence of excess risk of vba stroke associated. In this guest post, stephen perle from university of bridgeport discusses the findings and their limitations. The vertebral artery vba, located in the neck, supplies blood to the brain. The positive association between pcp visits and vba stroke is most likely due to patient decisions to seek care for the symptoms headache and neck pain of arterial dissection. Safety of chiropractic manipulation of the cervical spine.
Vertebrobasilar disease the vascular surgery team at the university of michigan is dedicated to providing exceptional treatments for vertebrobasilar disease in the um cardiovascular center cvc, our new stateoftheart clinical facility. Considerations to improve the safety of cervical spine manual therapy. We conclude that manipulation is an unlikely cause of vba stroke. We found no evidence of excess risk of vba stroke associated chiropractic care compared to primary care. A risk benefit assessment strategy to exclude cervical artery dissection in spinal manualtherapy. Recently, i had the pleasure of reading a study by j. Stroke risk associated with aggressive chiropractic neck. Risk of vertebrobasilar stroke and chiropractic care risk of vertebrobasilar stroke and chiropractic care cassidy, j boyle, eleanor. Chiropractic case study the risk of stroke with spinal. There is controversy surrounding the risk of manipulation, which is often used by chiropractors, with respect to its association with vertebrobasilar artery system vba stroke. We found no evidence of excess risk of vba stroke associated chiropracticcare compared to primary care. This page contains the article risk of vertebrobasilar stroke and chiropractic care. In the chiropractic cohort, the adjusted risk of stroke was significantly lower at 7 days as compared to the primary care cohort hazard ratio, 0. Jun 16, 2015 there is controversy surrounding the risk of manipulation, which is often used by chiropractors, with respect to its association with vertebrobasilar artery system vba stroke.
Jun 19, 2015 chiropractic care and the risk of vertebrobasilar stroke. The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation. A recent article suggested that case misclassification in the casecontrol studies on this topic resulted in biased. 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. The chiropractic community is aware of the association between neck manipulation and stroke, which is an issue that has simmered for about five years now, said keith overland, immediate past. The anatomic explanation of how spinal manipulative therapy could cause a stroke is well documented. Cassidy jd1, boyle e, cote p, he y, hoggjohnson s, silver fl, bondy sj.
The objective of this study was to compare the associations between chiropractic care and vba stroke with recent primary care physician pcp care and vba stroke. Pdf risk of vertebrobasilar stroke and chiropractic care. Neck pain is a common problem associated with consid. No study has yet found an association between chiropractic utilization and vba diagnoses at the population level. The first important thing to note is that the risks of spinal adjustments and spinal. The odds ratio for pcps is a separate issue and we dont know what it means. The cassidy study confirmed previous findings of an association between vertebrobasilar artery stroke and chiropractic visits in those under 45 years of age. Risk of stroke after chiropractic spinal manipulation in. Risk of vertebrobasilar stroke and chiropractic care. Pdf chiropractic care and the risk of vertebrobasilar. Chiropractic care and the risk of vertebrobasilar stroke on. A riskbenefit assessment strategy to exclude cervical artery dissection in spinal manualtherapy. Does case misclassification threaten the validity of. To investigate associations between chiropractic visits and vertebrobasilar artery vba stroke and to contrast this with primary care physician pcp visits and vba stroke.
Original research risk of stroke after chiropractic spinal manipulation in medicare bbeneficiaries aged 66 to 99 years with neck pain james m. This doesnt mean a person shouldnt pursue chiropractic therapy, but we do advise our patients to avoid highvelocity neck manipulation. Spine volume 33, number 4s, pp s176s183 2008, lippincott. If a tear also called a dissection occurs in the vba, the resulting blood clot may obstruct blood flow, causing stroke symptoms. There is also an association between vertebrobasilar artery stroke and use of primary care physician visits in all age groups. Request pdf risk of vertebrobasilar stroke and chiropractic care study design populationbased, casecontrol and casecrossover study. Investigate the association between chiropractic manipulative treatment and vertebrobasilar artery stroke. Manipulation of the cervical spine is a treatment for neck pain often performed by chiropractic.
The purpose of this study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for medicare beneficiaries aged 66 to 99 years with neck pain. Results from the 2012 national health interview survey. Results of a populationbased casecontrol and casecrossover study. The purpose of this study was to quantify risk of stroke after. The study included 818 cases of vertibrobasilar strokes that were admitted to ontario hospitals between 1993 and 2002. Does chiropractic care increase the risk of vertebrobasilar stroke. Chiropractic manipulation to the neck is believed to be a risk factor for vba stroke. We compared hazard of vertebrobasilar stroke and any stroke at 7 and 30 days after office visit using a. Palmer chiropractic position paper on adjustments and the.
Stroke, 3 patients who present with low back pain and acquire neck pain or vice versa, 4 exacerbation of existing. Our canadian colleagues should be congratulated for providing us with some objective data on what has been a highly controversial topic for over 40 years, r1 namely, the relationship between stroke and chiropractic manipulation. Risk of stroke after chiropractic spinal manipulation in medicare b. Feb 29, 2008 vba stroke is a very rare event in the population. Compare the risk of injury via medicare data between two cohorts of patients treated by chiropractic spinal manipulation versus treatment by a primary care physician. The prevalence, patterns, and predictors of chiropractic use among us adults.