Stroke after chiropractic manipulation as a result of extracranial postero-inferior cerebellar artery dissection

A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation

“…One could speculate that maintaining a mid-line position for the supra-adjacent C0-C6 segments, a feature of both techniques, and applying these mobilizations below the entrance of the vertebral artery would likely contribute to enhanced safety and minimize the chance for AR. [7][8][9][10][11][12][13][14][15][16] The incidence of AR and the biomechanics of the manipulative technique that may have caused harm to patients with neck pain and movement impairment is difficult to assess, since only reported cases can be studied. 9,16,32 Thrust manipulation with a fast rotatory component occurring through multiple lower cervical segments may be the factor most associated with minor flare ups in cervical discomfort and more serious complications, such as causing disk herniation and producing radiculomedullary irritation because of pre-existing disk herniation or arterial injury.…”

“…9,16,32 Thrust manipulation with a fast rotatory component occurring through multiple lower cervical segments may be the factor most associated with minor flare ups in cervical discomfort and more serious complications, such as causing disk herniation and producing radiculomedullary irritation because of pre-existing disk herniation or arterial injury. [9][10][11][12][13][14][15][16][33][34][35] It is possible that application of manual intervention to the C7 segment, below the entrance of the vertebral artery and where the incidence of disk herniation is very low 23 may reduce the chance of AR. It has been…”

“…The researchers found that 70% of the MO and RIG have modified their teaching in a way that now limits the amount of cervical rotation used during manual intervention. The literature supports that cervical thrust manipulation with a rotatory component is at least controversial if not potentially dangerous [7][8][9][10][11][12][13][14][15][16] and that manual intervention applied to adjacent motion segments below the entrance of the vertebral artery may not only have short term benefit to our patients, but may also be safer. 17,19,20 Given this, and considering the work of Norlander et al, 21,22 who found that reduced mobility at the cervical-thoracic junction was a risk factor for neck pain, and Ozer et al, 23 who noted that disk herniations are very rare at the C7 segment, the objective for this clinical trial was formulated.…”

“…7,8 Studies have reported that and myelopathic disturbances. 11,12 Other studies have reported that this form of manipulation may be an independent risk factor for vertebral artery dissection 13 and a potential cause of stroke 14 or internal jugular vein thrombosis. 15 Further, osteophytic changes can compress and alter the anatomical configuration of the vertebral artery in the lower cervical transverse foramina beginning at the artery's C6 point of entrance.…”

The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation

“…Recent reports suggest an explanation for this inequity is the existence of subpopulations who may be predisposed to mechanical compromise [19] through anatomic [4,34], metabolic [30], or physiological anomalies [24,44]. It is also possible that cSMT may be provided to persons with dissections-in-progress; a subsequent stroke may therefore be circumstantial or aggravated, but not initiated, by cSMT.…”