ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2023
The association between cervical artery dissection and spinal manipulation among US adults.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Risk factors for cervical artery dissection: a systematic review with meta-analysis.Stroke and vascular neurology · 2026Pooled it
- Ischemic Stroke Associated With Vertebral Artery Occlusion Following Cervical Spine Manipulation in a Young Woman With Underlying Vascular Risk Factors: A Case Report.Clinical case reports · 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
- Rare anatomical variant of a duplicate renal vein traversing through the L1 vertebral body in a U.S. Veteran presenting with spine pain: an imaging case review.The Journal of the Canadian Chiropractic Association · 2026Article
- Acute aortic dissection presenting as crossed neurological symptoms: a case report.Frontiers in medicine · 2026Article
- 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
- Vertebral Artery Dissection Following High Velocity Low Amplitude Cervical Manipulation: A Case Report.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
- Plausible Mechanisms of Causation of Immediate Stroke by Cervical Spine Manipulation: A Narrative Review.Cureus · 2024Review
- Review
Corrections and comments
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Authors and funding
6 authors at 5 institutions in 1 country.
Funding
Abstract
purposeCervical artery dissection (CeAD), which includes both vertebral artery dissection (VAD) and carotid artery dissection (CAD), is the most serious safety concern associated with cervical spinal manipulation (CSM). We evaluated the association between CSM and CeAD among US adults.
methodsThrough analysis of health claims data, we employed a case-control study with matched controls, a case-control design in which controls were diagnosed with ischemic stroke, and a case-crossover design in which recent exposures were compared to exposures in the same case that occurred 6-7 months earlier. We evaluated the association between CeAD and the 3-level exposure, CSM versus office visit for medical evaluation and management (E&M) versus neither, with E&M set as the referent group.
resultsWe identified 2337 VAD cases and 2916 CAD cases. Compared to population controls, VAD cases were 0.17 (95% CI 0.09 to 0.32) times as likely to have received CSM in the previous week as compared to E&M. In other words, E&M was about 5 times more likely than CSM in the previous week in cases, relative to controls. CSM was 2.53 (95% CI 1.71 to 3.68) times as likely as E&M in the previous week among individuals with VAD than among individuals experiencing a stroke without CeAD. In the case-crossover study, CSM was 0.38 (95% CI 0.15 to 0.91) times as likely as E&M in the week before a VAD, relative to 6 months earlier. In other words, E&M was approximately 3 times more likely than CSM in the previous week in cases, relative to controls. Results for the 14-day and 30-day timeframes were similar to those at one week.
conclusionAmong privately insured US adults, the overall risk of CeAD is very low. Prior receipt of CSM was more likely than E&M among VAD patients as compared to stroke patients. However, for CAD patients as compared to stroke patients, as well as for both VAD and CAD patients in comparison with population controls and in case-crossover analysis, prior receipt of E&M was more likely than CSM.
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