ArticleCureus2016
Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation.
Article in Cureus, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06389188 (Effectiveness of Cervical Osteopathic Manipulation Techniques of High Velocity and Low Amplitude in Patients With Whiplash- Associated Disorders), which is not on this map. Cited by 44 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effectiveness of Cervical Osteopathic Manipulation Techniques of High Velocity and Low Amplitude in Patients With Whiplash- Associated Disorders
Who cites it
44 citing papers in PubMed, 5 syntheses or guidelines pooled it, 80 citations in OpenAlex.
- Adverse events following cervical spine self-manipulation: A systematic review.PM & R : the journal of injury, function, and rehabilitation · 2026Pooled it
- The effects of mobilization and manipulation on mortality and structure, function and inflammatory markers in cervical blood vessels: a systematic review and meta-analysis of studies in healthy animals and animals with pre-existing vascular pathology.Frontiers in cardiovascular medicine · 2025Pooled it
- Mechanisms of manipulation: a systematic review of the literature on immediate anatomical structural or positional changes in response to manually delivered high-velocity, low-amplitude spinal manipulation.Chiropractic & manual therapies · 2024Pooled it
- Reporting of adverse events associated with spinal manipulation in randomised clinical trials: an updated systematic review.BMJ open · 2023Pooled it
- The risk associated with spinal manipulation: an overview of reviews.Systematic reviews · 2017Pooled it
- Multimodal chiropractic care for migraine: A pilot randomized controlled trial.Cephalalgia : an international journal of headache · 2021Trial
- Chiropractic patient compensation claims in Norway from 2013 to 2024.Chiropractic & manual therapies · 2026Article
- Association between spinal manipulative therapy and cervical artery dissection in patients with neck pain or headache: a retrospective cohort study.Chiropractic & manual therapies · 2026Article
- Educational approaches to the relationship between cervical adjusting and risk of cervical artery dissection; a survey of chiropractic faculty.Chiropractic & manual therapies · 2026Article
- Effects of Spinal Manipulation and Dry Needling on Headache and Migraine: A Systematic Review of Randomized Controlled Trials.Journal of clinical medicine · 2026Review
- Compensation claims for chiropractic in Denmark 2013-2022.Chiropractic & manual therapies · 2026Article
- Selective criticism confounds objective evaluation of case report on spinal manipulation and vertebral artery dissection.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Internal carotid artery dissection manifesting as paracentral acute middle maculopathy: a case report and review of literature.BMC ophthalmology · 2025Review
- Missing information and selective reporting confounds the literature on the association between spinal manipulation and vertebral artery dissection.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Article
- Recognition of Vertebral Artery Dissection in a High-Risk Postpartum Patient by a Chiropractic Physician.Cureus · 2025Article
- Combined chiropractic care and Tai Chi for chronic neck pain: A protocol for a pilot randomized trial.Contemporary clinical trials communications · 2025Article
- Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations.Journal of clinical medicine · 2024Review
- Cervical Spine Manipulation and Causation of Cervical Artery Dissection: A Review of 10 Case Reports.Cureus · 2024Review
- Plausible Mechanisms of Causation of Immediate Stroke by Cervical Spine Manipulation: A Narrative Review.Cureus · 2024Review
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCase reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD.
methodsSearch terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria.
resultsOur search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was "very low."
conclusionsThe quality of the published literature on the relationship between chiropractic manipulation and CAD is very low. Our analysis shows a small association between chiropractic neck manipulation and cervical artery dissection. This relationship may be explained by the high risk of bias and confounding in the available studies, and in particular by the known association of neck pain with CAD and with chiropractic manipulation. There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.