Original article in Dynamic Chiropractic Vol 37, Number 12, December 2019
As I was reading the latest addition of Dynamic Chiropractic, I couldn’t help but cringe when I saw the title. As a chiropractor or a chiropractic enthusiast how could you not? One of the potential dark clouds of our profession splashed across the front page. I remember at Palmer, this was certainly a topic of concern. This was ten years ago and I still remember the stat, in 100 years the medical community was trying to link 20 cases of stroke with chiropractic. Considering the amount of adjustments given daily, weekly, monthly since the late 1800’s, the odds are still in our favor. No matter how small the risk, our profession is still held liable and I know it’s one of the biggest concerns by new patients when they come through my doors. Knowledge, more research and chiropractors staying on their toes, the risk of a vertebral artery dissection can still be very low and preventable.
The main thrust of the article is reviewing a collage of cases in which a manual cervical adjustment was administered to a patient and subsequently they experienced a vertebral artery dissection. Yep, heavy stuff for sure. Even in the article (all written by chiropractors) there is a debate whether the administering chiropractor did everything in their power to rule out the possible risk of their patient have a vertebral artery embolism just lying in wait. One examiner says they did and the other says they did not.
Let me explain…
A female patient presented to their chiropractor with neck pain and idiopathic onset of headaches. The patient had not seen the chiropractor in many months. The chiropractor assumed it was the same cervicalgia and headaches the patient always had. No range of motion, neuromuscular or orthopedic tests were done on the head and neck. The chiropractic did do a history and brief examination and determined “out of adjustment at C2.” A manual cervical adjustment was given and within 20 seconds the patient suffered a vertebrobasilar artery dissection. The conundrum of the article is, was the artery already tearing free at that moment or did the adjustment break it free? With a thorough re-examination would the chiropractor have caught the symptoms before giving the adjustment which would allowed the chiropractor to refer the patient for immediate medical attention? Immediate medical attention could have minimized the effects of the stroke and with the patient being transported to the hospital with suspicion of vertebrobasilar artery dissection the chiropractor would also not have done a manual cervical manipulation…hopefully.
The verdict (literally) is still out and how much responsibility the chiropractor is being held too.
What exactly is a vertebral artery dissection? For your reviewing pleasure, “VAD is a flap like tear of the inner lining of the vertebral artery, which is in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery and blocking blood flow.”
Symptoms chiropractors need to watch for:
Some of these symptoms are similar to a stroke, any indications of a potential stroke or VAD DO NOT TOUCH or MANUALLY ADJUST the patient. Call 911, have them transported to the nearest hospital. This way you will be deemed a hero.
There are lots of websites with VAD information
Kassandra Schultz D.C