The recent news story about USA university graduate Caitlin Jensen serves as a reminder of the care that must be taken when chiropractic adjustments are performed. Tragically, Caitlin suffered four dissected arteries in her neck shortly after undergoing what was meant to be a simple manipulation, leading to cardiac arrest, stroke and a traumatic brain injury.
A journal article published in December 2021 confirms that traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45. Recent chiropractic neck manipulation is associated with a risk of vertebral artery dissection (VAD). A particular segment of the vertebral artery – the V3 segment – is highly susceptible to the bending forces which are applied during forced manipulation, which can lead to damage.
The article refers to the case presentation of a 44 year old male who reported sudden onset of loss of the left half of the visual field in both eyes after receiving a high velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior. CT angiogram of the head and neck revealed bilateral vertebral artery dissection and MRI of the brain confirmed an acute infarct (stroke).
The article concluded that education about the association of VAD and chiropractic maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. Detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients.
A 2014 published study of compensation claims for chiropractic treatment in Denmark and Norway from 2004-2012 found that while the majority of reported adverse events are mild and transitory, financial compensation claims were approved for such things as worsening of symptoms, alleged disc herniation and cases with delayed referral. Complaints relating to a cervical artery dissection accounted for 88.7% of the total amount paid in compensation.
Evaluating the appropriateness of cervical manipulation in high-risk patients, taking a complete and accurate medical history and obtaining informed consent all form part of the reasonable care to be provided by a chiropractor in the treatment of their patients.
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