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Chiropractic manipulation of the neck is contraindicated in the presence of
a nearby bone fracture, bone disease, or when there is disc rupture with severe
neurological findings. Differentiating these conditions from those in which
manipulation is indicated is a routine part of the normal chiropractic diagnostic
procedure.
Vertebral Artery Dissection (VAD)
In the last ten years, a number of studies have appeared in medical journals
that have found that a small percentage of patients who suffered a vertebral
artery dissection (VAD) had cervical spinal manipulation at some time prior
to the VAD incident. VAD is a weakening or tear of the artery in the upper cervical
region which forms a blood clot that can block the flow of blood in the vessel.
This blockage can lead to a stroke, a sudden deficit in the nervous system usually
caused by lack of oxygen to the brain.
Roles Played by Plaques and Emboli
Most strokes are caused by narrowing of arteries from plaques. Plaques are fatty
deposits that form on the lining of the artery (atherosclerosis) or by emboli.
Emboli are pieces of plaque that have broken loose and block an artery. Factors
association with various heart diseases can also cause stroke. VAD is considered
a less common cause of stroke that primarily affects patients under 45-years
of age.
Underlying Disorders
Most authors consider that an underlying disorder of the arteries must be present
in order for a VAD to develop. Some disorders being considered that may make
vessels vulnerable include conditions such as fibromuscular dysplasia, Marfan's
syndrome, cystic medial necrosis, connective tissue abnormalities, and infection
in the weeks prior to a VAD incident. While significant efforts have been made
to identify and list warning signs, there are none yet that identify those patients
at risk for VAD.
Retrospective Studies
The studies that associate VAD with spinal manipulation are "retrospective"
studies, meaning they are based on the records of neurologists who treat stroke
and identify patients who have had prior cervical spinal manipulation. In these
studies, approximately 117 cases of post-manipulation stroke were reported in
English language journals as of 2002.
According to the standards of scientific literature, these retrospective studies
offer indications for future research, but they are not considered adequate
to prove a "cause and effect" relationship. Unfortunately, stories appearing
in the popular media ignored the tentative nature of this research and jumped
to a more dramatic conclusion with warnings regarding the safety of cervical
spinal manipulation.
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