Abstract
Benedict Wand and colleagues (doi:10.1136/bmj.e3679) argue that the risks of cervical spine manipulation are not justified, but David Cassidy and colleagues think it is a valuable addition to patient care
Highlights
The controversy surrounding the association between manipulation and neurovascular complications is longstanding and not fully resolved, partly because it is difficult to obtain conclusive evidence on rare adverse events
Cervical spine manipulation is a common treatment option for mechanical neck pain yet may carry the potential for serious neurovascular complications, vertebral artery dissection and subsequent vertebrobasilar stroke
The estimates for stroke resulting from vertebral artery dissection are lower still, ranging from 0.75 to 1.12 per 100 000 person years,[2] and many are unlikely to be the result of cervical manipulation
Summary
The controversy surrounding the association between manipulation and neurovascular complications is longstanding and not fully resolved, partly because it is difficult to obtain conclusive evidence on rare adverse events.
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