Is cervical spinal manipulation dangerous?
OBJECTIVE
Concern about cerebrovascular accidents after cervical manipulation is common. We report a case of cerebrovascular infarction without sequelae.


METHODS
A 39-year-old man with nonspecific neck pain was treated by his general practitioner with cervical manipulation.


RESULTS
This immediately elicited severe headache and neurologic symptoms that disappeared completely within 3 months despite permanent signs of a complete left-sided cerebellar infarction on computed tomography and magnetic resonance imaging. At 7-year follow-up the patient was fully employed, and repeated magnetic resonance imaging still showed infarction of the left cerebellar hemisphere. However, the patient remained completely free of neurologic symptoms, and color duplex ultrasonography showed normal cervical vessels, including patent vertebral arteries.


CONCLUSIONS
It appears that the risk of cerebrovascular accidents after cervical manipulation is low, considering the enormous number of treatments given each year, and very much lower than the risk of serious complications associated with generally accepted surgery. Provided there is a solid indication for cervical manipulation, we believe that the risk involved is acceptably low and that the fear of serious complications is greatly exaggerated.
Licht
Peter B
PB
Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital, DK-5000 Odense, Denmark. peter.licht@sks.aaa.dk
Christensen
Henrik W
HW
Høilund-Carlsen
Poul F
PF
D000328:Adult; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000009:adverse effects*; D019547:Neck Pain / Q000628:therapy; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000473:pathology