Advertisement

Journal of Neurology

, Volume 253, Issue 6, pp 724–730 | Cite as

Vertebral artery dissections after chiropractic neck manipulation in Germany over three years

  • U. Reuter
  • M. Hämling
  • I. Kavuk
  • K. M. Einhäupl
  • E. Schielke
  • for the German vertebral artery dissection study group
ORIGINAL COMMUNICATION

Abstract

Vertebral artery dissection (VAD) has been observed in association with chirotherapy of the neck. However, most publications describe only single case reports or a small number of cases. We analyzed data from neurological departments at university hospitals in Germany over a three year period of time of subjects with vertebral artery dissections associated with chiropractic neck manipulation. We conducted a countrywide survey at neurological departments of all medical schools to identify patients with VAD after chirotherapy followed by a standardized questionnaire for each patient. 36 patients (mean age 40 + 11 years) with VAD were identified in 13 neurological departments. Clinical symptoms consistent with VAD started in 55% of patients within 12 hours after neck manipulation. Diagnosis of VAD was established in most cases using digital subtraction angiography (DSA), magnetic resonance angiography (MRA) or duplex sonography. 90% of patients admitted to hospital showed focal neurological deficits and among these 11 % had a reduced level of consciousness. 50% of subjects were discharged after 20 ± 14 hospital days with focal neurological deficits, 1 patient died and 1 was in a persistent vegetative state. Risk factors associated with artery dissections (e. g. fibromuscular dysplasia) were present in only 25% of subjects.

In summary, we describe the clinical pattern of 36 patients with vertebral artery dissections and prior chiropractic neck manipulation.

Key words

chiropractic neck manipulation artery dissection disability 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Assendelft WJ, Bouter LM, Knipschild PG (1996) Complications of spinal manipulation: a comprehensive review of the literature. J Fam Pract 42:475–480PubMedGoogle Scholar
  2. 2.
    Astin JA, Ernst E (2002) The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalalgia 22:617–623PubMedCrossRefGoogle Scholar
  3. 3.
    Bernau A (1987) Commentary on the article “Is the mechanical traction of the cervical spine still acceptable?” by R Dorian. Z Orthop Ihre Grenzgeb 125:327–331PubMedCrossRefGoogle Scholar
  4. 4.
    Bradac GB, Kaernbach A, Bolk-Weischedel D, Finck GA (1981) Spontaneous dissecting aneurysm of cervical cerebral arteries. Report of six cases and review of the literature. Neuroradiology 21:149–154PubMedGoogle Scholar
  5. 5.
    Brandt T, Orberk E, Weber R, Werner I, Busse O, Muller BT, Wigger F, Grau A, Grond-Ginsbach C, Hausser I (2001) Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology 57:24–30PubMedGoogle Scholar
  6. 6.
    Czechowsky D, Hill MD (2002) Neurological outcome and quality of life after stroke due to vertebral artery dissection. Cerebrovasc Dis 13:192–197PubMedCrossRefGoogle Scholar
  7. 7.
    Ducrocq X, Lacour JC, Debouverie M, Bracard S, Girard F, Weber M (1999) Cerebral ischemic accidents in young subjects, A prospective study of 296 patients aged 16 to 45 years. Rev Neurol (Paris) 155:575–582PubMedGoogle Scholar
  8. 8.
    Frisoni GB, Anzola GP (1991) Vertebrobasilar ischemia after neck motion. Stroke 22:1452–1460PubMedGoogle Scholar
  9. 9.
    Gonzales-Portillo F, Bruno A, Biller J (2002) Outcome of extracranial cervicocephalic arterial dissections: a followup study. Neurol Res 24:395–398PubMedCrossRefGoogle Scholar
  10. 10.
    Guillon B, Bousser MG (2002) Epidemiology and pathophysiology of spontaneous cervical artery dissection. J Neuroradiol 29:241–249PubMedGoogle Scholar
  11. 11.
    Haldeman S, Carey P, Townsend M, Papadopoulos C (2001) Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 165:905–906PubMedGoogle Scholar
  12. 12.
    Haldeman S, Kohlbeck FJ, McGregor M (2002) Stroke, cerebral artery dissection, and cervical spine manipulation therapy. J Neurol 249:1098–1104PubMedCrossRefGoogle Scholar
  13. 13.
    Haldeman S, Kohlbeck FJ, McGregor M (2002) Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation. Spine 27:49–55PubMedCrossRefGoogle Scholar
  14. 14.
    Horn SW 2nd (1983) The “Locked-In” syndrome following chiropractic manipulation of the cervical spine. Ann Emerg Med 12:648–650PubMedCrossRefGoogle Scholar
  15. 15.
    Hufnagel A, Hammers A, Schonle PW, Bohm KD, Leonhardt G (1999) Stroke following chiropractic manipulation of the cervical spine. J Neurol 246:683–688PubMedCrossRefGoogle Scholar
  16. 16.
    Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG (1996) Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 21:1746–1759PubMedCrossRefGoogle Scholar
  17. 17.
    Masuhr F, Einhaupl K (1999) Treatment of ischaemic stroke. Thromb Haemost 82:85–91PubMedGoogle Scholar
  18. 18.
    Mokri B, Houser OW, Sandok BA, Piepgras DG (1988) Spontaneous dissections of the vertebral arteries. Neurology 38:880–885PubMedGoogle Scholar
  19. 19.
    Parenti G, Orlandi G, Bianchi M, Renna M, Martini A, Murri L (1999) Vertebral and carotid artery dissection following chiropractic cervical manipulation. Neurosurg Rev 22:127–129PubMedCrossRefGoogle Scholar
  20. 20.
    Peters M, Bohl J, Thomke F, Kallen KJ, Mahlzahn K, Wandel E, Meyer zum Buschenfelde KH (1995) Dissection of the internal carotid artery after chiropractic manipulation of the neck. Neurology 45:2284–2286PubMedGoogle Scholar
  21. 21.
    Pezzini A, Del Zotto E, Padovani A (2002) Hyperhomocysteinemia: a potential risk factor for cervical artery dissection following chiropractic manipulation of the cervical spine. J Neurol 249:1401–1403PubMedCrossRefGoogle Scholar
  22. 22.
    Rothwell DM, Bondy SJ, Williams JI (2001) Chiropractic manipulation and stroke: a population-based case-control study. Stroke 32:1054–1060PubMedGoogle Scholar
  23. 23.
    Rothwell PM, Norris JW (2002) Cerebrovascular complications of therapeutic neck manipulation. The need for reliable data on risks and risk factors. J Neurol 249:1105–1106PubMedCrossRefGoogle Scholar
  24. 24.
    Schievink WI, Mokri B, Whisnant JP (1993) Internal carotid artery dissection in a community. Rochester, Minnesota, 1987–1992. Stroke 24:1678–1680PubMedGoogle Scholar
  25. 25.
    Schievink WI, Mokri B, O’Fallon WM (1994) Recurrent spontaneous cervical-artery dissection. N Engl J Med 330:393–397PubMedCrossRefGoogle Scholar
  26. 26.
    Schievink WI (2000) The treatment of spontaneous carotid and vertebral artery dissections. Curr Opin Cardiol 15:316–321PubMedCrossRefGoogle Scholar
  27. 27.
    Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906PubMedCrossRefGoogle Scholar
  28. 28.
    Senstad O, Leboeuf-Yde C, Borchgrevink C (1996) Predictors of side effects to spinal manipulative therapy. J Manipulative Physiol Ther 19:441–445PubMedGoogle Scholar
  29. 29.
    Senstad O, Leboeuf-Yde C, Borchgrevink C (1998) Frequency and characteristics of side effects of spinal manipulative therapy. Spine 22:435–440CrossRefGoogle Scholar
  30. 30.
    Showalter W, Esekogwu V, Newton KI, Henderson SO (1997) Vertebral artery dissection. Acad Emerg Med 4:991–995PubMedCrossRefGoogle Scholar
  31. 31.
    Siegel D, Neiders T (2001) Vertebral artery dissection and pontine infarct after chiropractic manipulation. Am J Emerg Med 19:171–172PubMedCrossRefGoogle Scholar
  32. 32.
    Smith WS, Johnston SC, Skalabrin EJ, Weaver M, Azari P, Albers GW, Gress DR (2003) Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology 60:1424–1428PubMedGoogle Scholar
  33. 33.
    Touze E, Gauvrit JY (2002) Natural history of cervical arterial dissections, Review of the literature and preliminary results from a national study group. J Neuroradiol 29:251–256PubMedGoogle Scholar
  34. 34.
    Vickers A, Zollman C (1999) ABC of complementary medicine. The manipulative therapies: osteopathy and chiropractic. BMJ 319:1176–1179PubMedGoogle Scholar
  35. 35.
    Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, Kuhlenbaumer G, Stogbauer F, Ringelstein EB (2003) Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 250:1179–1184PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • U. Reuter
    • 1
  • M. Hämling
    • 1
  • I. Kavuk
    • 3
  • K. M. Einhäupl
    • 1
  • E. Schielke
    • 1
    • 2
  • for the German vertebral artery dissection study group
  1. 1.Charité-Universitätsmedizin Berlin Dept. of NeurologyBerlinGermany
  2. 2.Department of NeurologyAuguste Viktoria KlinikumBerlinGermany
  3. 3.Department of NeurologyUniversity of EssenEssenGermany

Personalised recommendations