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(Stroke. 2001;32:809.)
© 2001 American Heart Association, Inc.

Comments, Opinions, and Reviews

Life-Threatening Complications of Spinal Manipulation

E. Ernst, MD, PhD, FRCP(Edin)

From the Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter, UK.

Correspondence to E. Ernst, MD, PhD, FRCP(Edin), Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, 25 Victoria Park Rd, Exeter EX2 4NT, UK. E-mail E.Ernst@ex.ac.uk

Key Words: manipulation, spinal • spinal injuries

	Introduction

 
Spinal manipulation entails high-velocity, low-amplitude manual thrusts to spinal joints that extend slightly beyond their physiological range of motion. It is a therapeutic technique often, but not exclusively, used by chiropractors who tend to believe that it is not associated with relevant risks. This opinion is contrasted by the findings of systematic reviews,¹ which summarize several hundred cases of serious complications after spinal manipulation, mostly of the upper spine. Chiropractors rightly point out that many of these instances relate to events that happened decades ago. Thus, it is relevant to ask whether life-threatening complications still occur or whether therapists have now learned how to avoid such effects.

Spinal manipulation has recently been associated with dissection of the vertebral² and internal carotid artery,³ resulting in strokes and at least 1 death.⁴ Other recent instances relate to epidermal hematoma,⁵ intracranial aneurysm,⁶ cauda equina syndrome,⁷ contusion of the spinal cord,⁸ myelopathy and radiocolopathy,⁹ as well as palsy of the long thoracic nerve.¹⁰ Case series from the Ukraine,¹¹ Sweden,¹² and Germany¹³ have contributed 49, 21, and 10 further patients, respectively, who suffered life-threatening events after spinal manipulation. Retrospective surveys carried out with doctors in California,¹⁴ Ireland,¹⁵ and Great Britain¹⁶ brought a total of 145 further series cases to light that would otherwise not have been documented in the medical literature.

None of these reports lends itself to defining incidence figures. The best way to arrive at such information is to prospectively study large samples of consecutive patients. Five such investigations have been published, and . . . [Full Text of this Article]

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