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Earlier this year we posted a blog about spinal maniplulation and stroke. That discussion was based upon two excellent resources from Cassidy and Koslov (1,2) The consensus of the story was:

These studies strengthen the premise that chiropractic manipulation may not increase the risk of VBAI stroke; rather, impending VBAI stroke patients may have a higher likelihood to seek care from a variety of providers, including chiropractors.

On Feb 16, 2016 another high quality study was been published in the respected online journal Cureus. (3) The authors performed Systematic Review and Meta-analysis of data concerning spinal manipulation and VBAI and concluded:

“There is no convincing evidence to support a causal link between chiropractic manipulation and Cervical Artery Dissection.”

Growing evidence refutes the notion that SMT is a causative factor for VBAI. However as responsible chiropractors, we must not allow these studies to lull us into a false sense of security. As stated earlier:

We should not dismiss the risk of stroke or any other reasonable threat. We must continue to carefully assess each patient’s history, adequately screen for vascular pathology prior to treatment, recognize & refer patients who require medical consultation and choose alternatives to cervical manipulation for higher risk patients.

The ChiroUp condition protocol for Cervicogenic Vertigo contains three pages of clinical considerations, including the following:

In patients with cervical complaints, headaches or dizziness, clinicians should search for clues that suggest a non-cervicogenic origin, including a history of head trauma, loss of consciousness, frequent unexplained falls, hearing loss, tinitis, ear “fullness”, earache, ptosis, facial or extremity paresthesia, visual disturbances, difficulty speaking, difficulty swallowing, ataxia, or a new medication- particularly anti-hypertensives or anti-depressants.

By remaining clinically vigilant, we will continue to provide patients with safe, effective treatment options.

1. Cassidy JD et al. Risk of vertebrobasilar stroke and chiropractic care: results of a population based case-control and case-crossover study. Spine 2008 Feb 15;33(4 Suppl):S176-83 http://www.vtchiro.org/Resources/Documents/Chiro%20Stroke%20Cassidy.pdf
2. Kosloff TM, Elto D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations. Chiropractic & Manual Therapies (2015) 23:19
3. Church E W, Sieg E P, Zalatimo O, et al. (February 16, 2016) Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus 8(2): e498. doi:10.7759/cureus.498

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