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(Stroke. 2001;32:1054.)
© 2001 American Heart Association, Inc.
Original Contributions |
Chiropractic Manipulation and Stroke
A Population-Based Case-Control Study
From the Institute for Clinical Evaluative Sciences (D.M.R., S.J.B., J.I.W.); Departments of Public Health Sciences (S.J.B., J.I.W.), Family and Community Medicine (J.I.W.), and Continuing Education (J.I.W.), University of Toronto; and Sunnybrook and Women’s College Health Sciences Centre (J.I.W.), Toronto, Ontario, Canada.
Background and Purpose—Several reports have linked chiropractic manipulation of the neck to dissection or occlusion of the vertebral artery. However, previous studies linking such strokes to neck manipulation consist primarily of uncontrolled case series. We designed a population-based nested case-control study to test the association.
Methods—Hospitalization records were used to identify vertebrobasilar accidents (VBAs) in Ontario, Canada, during 1993–1998. Each of 582 cases was age and sex matched to 4 controls from the Ontario population with no history of stroke at the event date. Public health insurance billing records were used to document use of chiropractic services before the event date.
Results—Results for
those aged <45 years showed VBA cases to be 5 times more likely than
controls to have visited a chiropractor within 1 week of the VBA (95%
CI from bootstrapping, 1.32 to 43.87). Additionally, in the
younger age group, cases were 5 times as likely to have had 
3 visits
with a cervical diagnosis in the month before the case’s VBA date
(95% CI from bootstrapping, 1.34 to 18.57). No significant
associations were found for those aged 45
years.
Conclusions—While our analysis is consistent with a positive association in young adults, potential sources of bias are also discussed. The rarity of VBAs makes this association difficult to study despite high volumes of chiropractic treatment. Because of the popularity of spinal manipulation, high-quality research on both its risks and benefits is recommended.
Editorial Comment
A Population-Based Case-Control Study
Service de Neurologie, Hôpital Lariboisière, Paris, France, marie-germaine.bousser@lrb.ap-hop.paris.fr
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