Cervical Spine Manipulation: An Alternative Medical Procedure with Potentially Fatal Complications

Andres Leon-Sanchez, MD; Albert Cuetter, MD; Gustavo Ferrer, MD

Disclosures

South Med J. 2007;100(2):201-203. 

In This Article

Abstract and Introduction

There are multiple reports in the literature of serious and at times fatal complications after cervical spine manipulation therapy (CSMT), even though CSMT is considered by some health providers to be an effective and safe therapeutic procedure for head and neck pain syndromes. We report a case of a young female with cervicalgia and headache with fatal posterior circulation cerebrovascular accident after CSMT. Serious complications are infrequent, with a reported incidence between one per 100,000 to one in 2 million manipulations. The most frequent injuries involve artery dissection or spasm. Stroke as a complication of cervical manipulation and dissection of the vertebral arteries (VAD) is a rare but well recognized problem. Neck pain, headache, vertigo, vomiting and ataxia are typical symptoms of VAD, but this vascular injury also can be asymptomatic. The most common risk factors are migraine, hypertension, oral contraceptive pills and smoking. Stroke following CSMT is more common than the literature reports. The best values derive from retrospective surveys. The lack of identifiable risk factors place those who undergo CSMT at risk of neurologic damage. Accurate patient information and early recognition of the symptoms are important to avoid catastrophic consequences.

Damage to the cerebellum and brainstem due to posterior circulation cerebrovascular accidents has been reported as a consequence of cervical spine manipulation therapy (CSMT).[1,2] Damage to such structures can be quickly fatal or may leave permanent neurologic deficit. Spinal manipulation therapy (SMT) is a manual form of treatment aimed mainly at reducing spinal pain and increasing range of motion.[3] It entails high-velocity, low-amplitude manual thrusts to the spinal joints that extend slightly beyond their physiologic range of motion.[4] Although SMT is considered by some health providers to be an effective and safe procedure for treating a variety of head and back pain syndromes, there are several reports in the literature that describe incidents of serious complications after CSMT.[1,2,5,6,7,8,9,10] We report a case of a young female with cervicalgia and headache with fatal posterior circulation cerebrovascular accident after CSMT.

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