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Strokes and Cervical Manipulation
According to a study by K.P. Lee et al. published in Neurology in 1995 and based on a survey of 486 neurologists, of whom 177 responded, out of 55 strokes examined, the majority of patients experienced these complications after cervical manipulation by chiropractors. Another lengthy article in Physical Therapy by R.P. Di Fabio, published in 1999, reported that out of 177 injuries following manipulation of the cervical spine, death happened in 18 percent of the cases. None of these deaths happened when physical therapists were involved in the manipulation. G.B. Frisoni and G.P. Anzola reported on cases of ischemic strokes after chiropractic manipulation of the cervical spine, noting that 28 percent of the cases involved death or serious long-term impairment (Stroke, 1991).
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Overall Chiropractic Safety for Adults
A search of PubMed, the National Library of Medicine’s database of more than 18 million articles, on the topic of Chiropractic and Adverse Effects produced 413 articles of which 71 were in-depth reviews. One such review by L.O. Gouveia in Spine, reporting on the dangers of chiropractic care found that out of 46 articles on adverse events, most were “benign and transitory,” although there were some life threatening complications reported, including “arterial dissection, myelopathy, vertebral disc extrusion and epidural hematoma.” The frequency of adverse events following chiropractic procedures varied between 33 and 60.9 percent. Serious events were between five strokes per 100,000 manipulations to 2.68 deaths per 10,000,000 manipulations. The reports varied so widely that the authors concluded there was insufficient robust data to make a definitive statement about the safety of chiropractic manipulation.
In another review by E. Ernst published in the Journal of Pain and Symptom Management in 2008, the authors claim “Manipulation is associated with frequent mild adverse effects and with serious complications of unknown incidence.” They go on to claim the ideas behind chiropractic are not based on any solid science nor has the value been demonstrated “beyond reasonable doubt.”
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Pediatric Use of Chiropractic
S. Vohra and others reviewing 13 published studies of chiropracty involving children under the age of 18 in Pediatrics, 2007, found both serious and minor adverse events in nine cases and 20 cases where the adverse effects were indirect, i.e., they involved delayed correct diagnoses of the real problems. Adverse events ranged from subarachnoidal hemorrhage or paralysis to simply soreness of the middle back.
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Based on multiple studies, there seems to be no doubt that chiropractics can involve some dangers, particularly when it involves the cervical spine. On the other hand, depending on the study, conventional medicine itself is either the leading cause of death in the U.S. (published in Life Extension Magazine) or the third leading cause (B. Starfield, writing in the Journal of the American Medical Association).
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Lee, KP, et al., “Neurologic complications following chiropractic manipulation: a survey of California neurologists,” Neurology 1995 Jun; 45(6):1213-5.
Di Fabio, RP, “Manipulation of the Cervical Spine: Risks and Benefits,” Physical Therapy, 1999 Jan; 79 (1):50-65.
Frisoni, GB and Anzola, GP, “Vertebrobasilar ischemia after neck motion,” Stroke 1991 22:1452-1460.
Gouveia, LO, Castanho P, and Ferreira, JJ, “Safety of chiropractic interventions: a systematic review,” Spine 2009 May 15;(11):E405-13.
Vohra, S, et al., “Adverse events associated with pediatric spinal manipulation: a systematic review,” Pediatrics 2007 Jan;119(1):e275-83. Epub 2006 Dec 18.
Life Extension Magazine: Death by Medicine -- http://www.lef.org/magazine/mag2004/mar2004_awsi_death_01.htm
Starfield, B., “Is US health really the best in the world?” Journal of the American Medical Association 2000, July 26; 284(4), 483-485
Quackwatch: Chiropractic's Dirty Secret: Neck Manipulation and Strokes http://www.quackwatch.com/01QuackeryRelatedTopics/chirostroke.html
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