Conservative Care

Chiropractic Cervical Manipulation Risks - Chiropractors Respond

Having heard a number of interesting responses from chiropractors about my previous post, Chiropractic Manipulation Risks, I thought it best to continue the debate by sharing some of the responses and comments with you.

Thomas Hyde, DC, DACBSP, Medical Advisor for Spine-health.com, wrote “While I think it is paramount that anyone who performs cervical manipulation should be trained in the signs and symptoms of pending strokes as well as how to take a complete and through history to be able to ascertain whether or not someone is a likely candidate for such a horrific event, there is no way that one can prevent with 100% certainty, a neurovascular accident in a certain percentage of the population.”

While estimates vary about what that percentage of the population is, a report published in the Canadian Medical Association Journal from Scott Haldeman, DC, MD, PhD (a chiropractor and neurologist – also a Spine-health.com Medical Advisor) et al stated “The likelihood that a chiropractor will be made aware of an arterial dissection following cervical manipulation is approximately 1 in 5.85 million cervical manipulations”.

Dr. Hyde points out that the extremely low incidence of stroke following cervical spinal manipulation begs the question “were these patients going to have a stroke anyway or was it the manipulation that caused the stroke?”

A 2005 review of current research by John J. Triano, DC, PhD (also a Spine-health Medical Advisor) et al. showed that there is no conclusive evidence of a causative relationship between cervical spinal manipulation and stroke, but there is an associative relationship, as patients experiencing symptoms of a stroke may be more likely to seek out chiropractic care.

This led to a proactive initiative – led by Dr. Triano and several others - to educate chiropractors about the myriad signs and symptoms of stroke so that they may better spot early symptoms and get the patient to an emergency room.

Kudos to these guys for responding this way – very much in the patient’s interest.

Posted by: Stephanie

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Subject: Even though the risks are

Even though the risks are small. We still need to proceed with caution. I don't care if the risks are 1 in 100 million.
Dr. Eben Davis
June 22nd, 2007

Subject: Dr. Hyde's comments are spot

Dr. Hyde's comments are spot on, in my opinion. The 'guilty by association' label is long overdue for removal. Recent evidence suggests that potential stroke sufferers are no more likely to experience an episode when visiting a chiropractor than whilst undergoing a routine physical examination with their medical practitioner. Maintaining perspective on risk/benefit ratio is imperative. Lets start focusing on scenarios that really are associated with practitioner-induced strokes. Anybody see the latest figures on perioperative stroke? Selim's article in the New England Journal of Medicine May edition makes for interesting reading (N Engl J Med. 2007 May 31;356).(22):2326.
Corrie Myburgh
June 21st, 2007

Subject: I don't think anyone would

I don't think anyone would argue with Dr. Davis about always proceeding with caution regardless of how small the risk is. We just need to put this into perspective when compared to other risks in medicine in general. What are the risks of developing bleeding with the use of NSAIDS? What are the risks of iatrogenic diseases with a trip to the hospital? Within medicine (generic), there are risks that are not often discussed with the patient and I feel it is our responsibility to inform every patient regardless of the type of treatment recommended for them, that ANY potential risk, regarless of how insignificant those numbers might be, should be discussed and the patient should then be given the opportunity to decide if that procedure is worth to risk to them personally.
tom hyde
June 28th, 2007