Entry 1 – cervical artery dissection risk with cervical manipulative therapy

In the last two weeks, I have learned a lot about cervical artery dissections with cervical
manipulative therapy. Before learning about this I was unaware of this risk. As someone
who has received chiropractic cervical adjustments for several years, this concerned me.
Also, as a future chiropractor, I will need to ensure that consent for all adjustments is gained
and therefore I need to be able to explain the potential risks of adjustments to patients.
Therefore, I enjoyed reading about the risk of cervical artery dissection by chiropractic
adjustments.

In looking through some journal articles about chiropractic manipulation and cervical artery
dissection there seems to be a lot of bias with opposing opinions. Currently, I have some
knowledge of the issue but not enough to be able to inform others about the risks. To find
the information the best place to find trustworthy information would be in journal articles
written by reputable health practitioners. In doing so I found one article that wrote that
chiropractic manipulations of the cervical spine were the leading cause of VAD and rarely
with CAD with subsequent stroke in 83% of cases (Hufnagel, Hammers, Schö nle, Bö hm, &
Leonhardt, 1999). Inversely a different article wrote that “there is no strong evidence in the
literature that manual therapy provokes CAD” (Chaibi & Russell, 2019). This second article is
written by a professor in neurology and practitioner of chiropractic, physiotherapy and
studies of headache disorders.

Therefore, because there is contradictory information in the literature that should be

reputable it is hard to know what to believe and what is true. The article by Chaibi and
Russell says that the history of a patient is vitally important as there are several
environmental, lifestyle and inherited factors that can increase the risks of cervical artery
dissection. Some of these factors include smoking, acute respiratory infection, family history
of arterial abnormalities and connective tissue disorders (Chaibi & Russell, 2019). Therefore,
while it is important to inform patients about risks, it is likely to be most effective to take a
detailed history of the patient and continue looking for symptoms throughout the
treatment of the patient.

This can be a team approach throughout chiropractic clinics where there is set information
that is supplied to patients before they give consent. The risks of cervical manipulation are
important to disclose to patients and therefore they can make a decision to receive
manipulation based on the available evidence. It is also important that patients inform the
chiropractor of all their personal and family history to help minimise the risk of cervical
artery dissection with adjustments.

Reference List
Chaibi, A., & Russell, M. B. (2019). A risk–benefit assessment strategy to exclude cervical
artery dissection in spinal manual- therapy: a comprehensive review. Annals of
Medicine.
Hufnagel, A., Hammers, A., Schö nle, P.-W., Bö hm, K.-D., & Leonhardt, G. (1999). Stroke
following chiropractic manipulation of the cervical spine. Journal of Neurology, 683-
688.