COMMENTARY

Be Gentle With Your Neck

Sandra Adamson Fryhofer, MD

Disclosures

December 26, 2014

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Hello. I'm Dr Sandra Fryhofer. Welcome to Medicine Matters.

The topic: neck manipulation and risk for cervical artery dissection—a new statement in the journal Stroke.[1] Here's why it matters. Cervical artery dissection is serious. It's most prevalent in the upper cervical spine and can involve the internal carotid or vertebral arteries. It's an important cause of stroke in both young and middle-aged patients. Dissections can be spontaneous or traumatic from causes as varied as a high-speed car crash to a sporting activity such as heavy weightlifting, even golf, tennis, or yoga, to ordinary activities such as sneezing and coughing. Dissection can also occur with cervical hyperextension or hyperrotation. It's been associated with CMT—cervical spine manipulation therapy—including adjustments by chiropractors. That's the point of this new report published in Stroke, which highlights the link between neck manipulation and cervical dissection.

Okay. Real story. Real patient. My patient. A new patient, a middle-aged executive, comes in with severe neck pain and headache worse than any headache he's ever had before. Earlier that day he'd seen a chiropractor. The diagnosis was left vertebral artery dissection, revealed by CT angiograms. My thought at the time was concern that manipulation by the chiropractor probably had a role. That was 10 years ago.

Neck pain is common, especially because we spend so much time typing on computers. Neck pain has many going to massages, maybe seeing chiropractors. But the lesson I learned from my patient is reinforced by this study. Be gentle with your neck. To paraphrase the researchers' findings, although a direct cause-and-effect relationship between neck manipulation and cervical artery dissection has not been established and the absolute risk is probably low, cervical artery dissection can result in serious neurologic injury.

Back to my patient. After 6 months of blood thinners he fully recovered, but he hasn't been back to see the chiropractor. The moral of this story: Be gentle with your neck and be aware of the link between cervical manipulation and cervical artery dissection.

For Medicine Matters, I'm Dr Sandra Fryhofer.

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