Abstract
BackgroundCervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.Purpose1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and 2) assess the quality of these reports.MethodsA systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.ResultsOverall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.ConclusionsThis study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.
Highlights
In the area of harms reporting, one topic that has received significant attention is cervical spinal manipulation therapy, an intervention most often administered by chiropractors [1,2] to treat musculoskeletal complaints of the head and neck [3] including headaches [4]
This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cervical spinal manipulation therapy (cSMT), cervical artery dissection (CAD) and stroke
This paper examined the quality of literature describing an association between cSMT and CAD
Summary
In the area of harms reporting, one topic that has received significant attention is cervical spinal manipulation therapy (cSMT), an intervention most often administered by chiropractors [1,2] to treat musculoskeletal complaints of the head and neck [3] including headaches [4]. If harms are associated with cSMT, they most commonly involve additional head and neck pain [2] While these adverse events tend to be self-limiting [2], more serious adverse events have been reported such as neurovascular sequelae and stroke. Injuries such as cervical artery dissection (CAD), whether vertebral, internal carotid, or vertebrobasilar, have been reported to be associated with Csmt [5,6,7]. Systematic reviews where harms have been reported often exclude non-RCTs [10], which can minimize useful information about the benefit-toharm ratio associated with treatment Given these circumstances, harms reporting often occurs through community-based passive surveillance, which is well known for under-reporting. Purpose: 1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and 2) assess the quality of these reports
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