Case Report

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

Authors: Andres Leon-Sanchez, MD, Albert Cuetter, MD, Gustavo Ferrer, MD

Abstract

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.


Key Points


* Cervical spine manipulation therapy may produce serious complications in selected populations.


* Some observational studies suggest that the low incidence of neurologic complications after cervical spine manipulation therapy should not outweigh the benefits of this technique.


* Studies have failed to recognize potential risk factors that may predispose people to develop neurologic complications when they undergo cervical spine manipulation therapy.

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