Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Table 2.

Case-Control Studies on the Association of Stroke and CMT

Author Methodology Population Measured Events
Rothwell et al,84 2001 Population-based nested case-control design All Ontario people admitted to acute care facility with a diagnosis of posterior circulation stroke from January 1993–December 1998 Age <45 y
Posterior circulation stroke within 1 wk of DC visit:
OR 5.03 (95% CI, 1.32–43.87)
Number of cervical chiropractic visits previous month (≥3 visits)
OR, 4.98 (95% CI, 1.34–18.57)
Age >45 y
Posterior circulations stroke within 1 wk of DC visit:
OR, 0.64 (95% CI, 0.25–1.67)
Number of cervical chiropractic visits previous month (≥3 visits)
OR, 1.60 (95% CI, 0.31–8.25)
Smith et al,117 2003 Institutional database query nested-case control study design Combined databases of 2 California academic stroke centers for all patients with acute ischemic stroke or TIA from 1995–2000. 1107 cohort, 151 dissections, 306 other identified strokes randomly selected as controls, age and sex matched. Final study group: 51 CAD and 100 controls selected Pain before stroke/TIA
All dissections (n=51): OR, 4.6 (95% CI, 2.1–10)
VAD (n=25): OR 3.8 (95% CI, 1.3–11)
ICAD (n=26): OR 4.7 (95% CI, 1.7–13)
SMT within 30 d
All dissections (n=51): NS
VAD (n=25): 6.6 (95% CI, 1.4–30)
ICAD (n=26): NS
Cassidy et al,67 2008 Population-based case-control and case-crossover study Cases: All residents of Ontario (109 020 875 person-years over 9 y) with posterior circulation strokes admitted to Ontario, Canada, hospitals, identified from discharge and OHIP databases. 818 posterior circulation strokes per 100 million person-years. 3164 controls matched to cases.
Case-controls: 4 age- and sex-matched controls randomly selected from the Registered Persons Database (listing of all healthcare numbers for Ontario)
Age <45 y
Posterior circulation stroke within 1 wk of any visit
DC: OR, 2.41 (95% CI, 0.98–5.95)
PCP: OR, 2.90 (95% CI, 1.64–5.13)
Posterior circulation stroke within 1 wk of headache of cervical DC visit
DC: OR, 3.11 (95% CI, 1.16–8.35)
PCP: OR, 20.00 (95% CI, 4.38–91.28)
Age >45 y
Posterior circulation stroke within 1 wk of any visit
DC: OR, 0.30 (95% CI, 0.12–0.77)
PCP: OR, 2.30 (95% CI, 2.85.3.85)
Posterior circulation stroke within 1 wk of headache of cervical DC visit
DC: OR 1.18 (95% CI, 0.16–1.66)
PCP: OR 6.99 (95% CI, 3.93–12.44)
Engelter et al,118 2013 Multicenter case-control study (Cervical Artery Dissection and Ischemic Stroke Patients) study in 18 centers in 8 countries designed to assess determinants of CD Cases: 966 cases of CD Controls: 651 age- and sex-matched non–CD-IS); 280 healthy subjects. Any trauma: OR, 7.6 (95% CI, 5.6–10.2) vs non–CD-IS,
OR, 3.7 (95% CI, 2.4–5.56) vs healthy subjects
CMT: OR, 11.9 (95% CI, 4.28–33.2) vs non–CD-IS,
OR, 3.6 (95% CI, 1.23–10.7) vs healthy subjects
  • CD indicates cervical artery dissection; CI, confidence interval; CMT, cervical manipulative therapy; DC, doctor of chiropractic; ICAD, internal carotid artery dissection; non–CD-IS, ischemia from other causes; NS, not significant; OHIP, Ontario Health Insurance Program; OR, odds ratio; PCP, primary care physician; SMT, spinal manipulative therapy; TIA, transient ischemic attack; and VAD, vertebral artery dissection.

This Article

  1. Stroke vol. 45 no. 10 3155-3174

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