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Zerebrovaskuläre Ereignisse

Risiken der zervikalen Manipulationsbehandlung im Licht neuerer Erkenntnisse - ein Überblick

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Zusammenfassung

Vieles deutet auf einen kausalen Zusammenhang zwischen Anomalien der arteriellen Gefäßstruktur und zerebrovaskulären Ereignissen hin, wobei erhöhte Homozysteinspiegel eine besondere Rolle spielen. Bezogen auf die zervikale Manipulationsbehandlung lassen die Ergebnisse der vorliegenden Arbeit darauf schließen, dass die Fragilität der arteriellen Gefäßwand im zerebrovaskulären Stromgebiet als Hauptursache arterieller Dissektionen anzusehen und weitaus bedeutender ist als irgendein durch die Manöver des behandelnden Therapeuten ausgelöste Trauma.

Das aktuelle Risiko zerebrovaskulärer Ereignisse, die in einem direkten Zusammenhang mit einer spinalen Manipulationsbehandlung stehen, ist verglichen mit den Risiken des alltäglichen Lebens bzw. den Risiken, die von der Allgemeinheit bei medizinischen Behandlungen akzeptiert werden, als gering einzuschätzen. Die Verbreitung von Risikoschätzungen in Verbindung mit einer chiropraktischen Therapie ohne Daten, welche dies eindeutig belegen, ist für die Bevölkerung sicherlich nicht dienlich, sondern eher schädlich. Mit der Bestimmung des Homozysteinspiegels steht eine klinische Methode zur Verfügung, die das aktuelle Risiko zerebrovaskulärer Ereignisse weiter reduzieren könnte. Zum gegenwärtigen Zeitpunkt scheint die Bestimmung des Homozysteinspiegels die überzeugendste Methode zur Klassifikation von Patienten zu sein, die das höchste Risiko für ein zerebrovaskuläres Ereignis bei alltäglichen Tätigkeiten bzw. bei einer zervikalen Manipulationsbehandlung aufweisen.

Abstract

Many signs point to intrinsic aberrations of arterial structure as an underlay for CVAs, many of them brought on by elevated levels of homocysteine. When applied to cervical manipulations, the body of evidence outlined in this report suggests that it is the inherent fragility of the arterial wall of the cerebrovascular system rather than any trauma associated with maneuvers performed by the attending physician that is the major culprit in the causation of arterial dissections. The actual risk of CVAs directly attributable to spinal manipulation can be seen to be far lower than is generally assumed when it is compared with everyday lifestyle risks and those inherent in medical treatments that are widely accepted by the public. Certainly the propagation of estimated risk levels of visits to the chiropractor's office without adequate justification from data does not constitute a useful service to the public; indeed, it is just the opposite. It appears that the determination of homocysteine levels as a clinical tool would afford the chiropractic physician a means of bringing down the actual risks of CVAs to even lower levels than those previously reported. In this regard, determination of homocysteine levels currently appears to be the most plausible means of finding which patients are most at risk of CVAs resulting from routine activities, quite apart from cervical manipulations.

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  1. Suite 315, Foundation for Chiropractic Education and Research, 1330 Beacon Street, Brookline, MA 02446-3202, USA

    A. L. Rosner

  2. Foundation for Chiropractic Education and Research, Brookline/MA, USA

    A. L. Rosner

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Rosner, A.L. Zerebrovaskuläre Ereignisse. Manuelle Medizin 41, 215–223 (2003). https://doi.org/10.1007/s00337-003-0217-0

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