article · Stroke
Background: Cervical artery dissection (CeAD) is an important cause of stroke in young adults. Some studies reported that nearly 100 million cervical chiropractic manipulations occur in the US annually. The relationship between chiropractic cervical manipulation and CeAD remains a matter of debate, with few large-scale studies examining incidence and clinical characteristics. Methods: We analyzed patients in the multi-center STOP-CAD registry (n=4,023) to identify CeAD cases diagnosed after chiropractic cervical manipulation. Demographics and clinical features were compared between CeAD with vs. without antecedent chiropractic manipulation using chi-square tests and t-tests. We built a multivariable binary logistic regression model that included factors associated with preceding chiropractic manipulation in univariate analyses i.e. those with p<0.05. Results: Of 4,023 CeAD cases, 228 (5.7%) were diagnosed with dissection after chiropractic cervical manipulation which is estimated to be a rare occurrence after all cervical chiropractic manipulations. In multivariable binary logistic regression, factors associated with prior cervical manipulation were younger age (OR per year 0.98 95% CI 0.97-0.99, p = 0.014), female sex (OR 1.64, 95% CI 1.21–2.23), absence of diabetes (OR 0.24, 95% CI 0.08–0.78), presence of neck pain (OR 2.80, 95% CI 2.08–3.77), and isolated vertebral dissection (OR 2.15, 95% CI 1.57–2.94). Recurrent ischemic stroke rates did not differ between the two groups. Conclusions: Nearly 1 in 20 cases of dissection reported antecedent cervical manipulation. Given the high frequency of cervical chiropractic manipulations and very low rates of dissections diagnosed after chiropractic manipulations, the likely risk of dissection associated with chiropractic manipulations is very low. Dissections diagnosed after cervical manipulation have a distinct profile and were more likely in younger women presenting with neck pain and isolated vertebral artery involvement. Whether the occurrence dissection preceded the cervical manipulation or not remains unclear.
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DOI: 10.1161/str.57.suppl_1.dp059
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