FROM:
J Manipulative Physiol Ther 2004 (Feb); 27 (2): 124–132 ~ FULL TEXT
Anthony L. Rosner, PhD
Foundation for Chiropractic Education and Research 1330 Beacon Street, Suite 315 Brookline, MA 02446-3202 USA
Over the past 5 to 10 years, the issue of cerebrovascular accidents (CVAs) and spinal manipulation has become a debate of ever-increasing intensity. A copious number of studies have investigated spinal manipulation as a putatative causative factor of CVAs [ 1-5 ]; however, a common theme among these is the failure to consider that the majority of vertebrobasilar accidents (VBAs) may be spontaneous, cumulative, or caused by factors other than spinal manipulation. The problem is not served by the sometimes hysterical reactions apparent in the media over the past 2 years in reaction to the flawed investigations. [ 6-11 ] In light of these recent reports, the entire phenomenon of spontaneous cervical artery dissections should be revisited to put this matter into a better perspective.
As shown in Table 1, the annual incidence of spontaneous VADs in hospital settings has been estimated to occur at the rate of 1 to 1.5 per 100,000 patients. [ 15 ] The corresponding VAD incidence rate in community settings has been reported to be twice as high. [ 16,17 ] Using an estimated value of 10 from the literature to represent an average number of manipulations per patient per episode, [ 23 ] it becomes apparent that the proposed exposure rate for CVAs attributed to spinal manipulation is equivalent to the spontaneous rates for cervical arterial dissections as reported. [ 15-17 ] If the threat of stroke or stroke-like symptoms is to be properly assessed, therefore, at least half our attention needs to be directed toward the spontaneous events instead of primarily or solely on spinal manipulation.
Read the rest now.
![[SWIRL 2]](../GRAPHICS/SWIRL-2.GIF)