MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

On 18/7/2022 the ‘WORLD FEDERATION OF CHIROPRACTIC’ published a statement on cervical artery dissection (CAD). Below are a few  excerpts to which I have added a few numbers [in brackets] which refer to my comments below:

… On rare occasions, CAD has been reported to have occurred after a patient visited a chiropractor or other provider of manual therapy [1]. However, the best evidence available to date indicates that spinal manipulation does not stress the arteries enough to cause tearing of the arteries leading to dissection-related strokes [2]. Additional studies have concluded that patients are as likely to have consulted a primary care physician as receive spinal manipulation from a chiropractor prior to experiencing a CAD-related stroke [3]…

The provision of safe, high-quality, evidence-based, patient-centered care for these and other conditions is a priority for the chiropractic profession [4]. Rigorous research is core to the pursuit of that objective [5]. We urge caution in making claims that are in conflict with the current state of the evidence.

About the WFC

The World Federation of Chiropractic is an international, non-governmental organization whose members are the national associations of over 90 countries in seven world regions. It is a non-state actor in official relations with the World Health Organization and is the global authority for matters related to the chiropractic profession [6]…

References

Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study. Eur Spine J. 2008 Apr;17(Suppl 1):176–83. Open access here.#

Chaibi A, Russell MB. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann Med. 2019 Mar;51(2):118-127. Open access here.

Church EW, Sieg EP, Zalatimo O, Hussain NS, Glantz M, Harbaugh RE. Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus. 2016 Feb 16;8(2):e498. Open access here.

Kosloff TM, Elton D, Tao J, Bannister WM. Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations. Chiropr Man Therap. 2015 Jun 16;23:19. Open access here.

Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S. A systematic review of the risk factors for cervical artery dissection. Stroke. 2005 Jul;36(7):1575-80. Open access here.

Whedon JM, Mackenzie TA, Phillips RB, Lurie JD. Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976). 2015 Feb 15;40(4):264-70. Open access here

Here are my brief comments based on the evidence discussed in dozens of posts previously published on this blog:

  1. As there is no post-marketing surveillance, nobody can say with any degree of confidence that CADs after chiropractic are rare.
  2. This is not the ‘best’ evidence. In fact, it has been refuted repeatedly.
  3. This study has also been refuted.
  4. Chiropractic is very far from being evidence-based.
  5. Rigorous research fails to show that chiropractic neck manipulations generate more good than harm.
  6. The WFC is a lobby group for chiropractic; its mission is ” to advance awareness, utilization, and integration of chiropractic internationally”. Its current director is Richard Brown who spear-headed the disaster when the BCA sued Simon Singh, lost, and caused immense reputational damage to chiropractic worldwide.

11 Responses to A statement on cervical artery dissection from the WORLD FEDERATION OF CHIROPRACTIC

  • I wonder if this WFC statement has anything do with a recent case of CAD being reported in the media: https://sciencebasedmedicine.org/chiropractic-neck-manipulations-in-the-news/

  • if yahs do yoga daily you won’t need any chiropractic assistance! and i mean on a two hourly programme starting with iyengar and moving to astanga (the latter a very disciplined and determined practice where i’ve seen 18 year old big wave surfers drop within seconds of starting the practice! – i’m 66!). try it and save yourselves your health, your life, your wealth! it will also enhance your mental capabilities, reduce or dissipate mental issues and keep one on the strait n narroW!

  • 1. NOT TRUE, as you well know the paper by Thiel et al. a prospective survey into Cx SMT side effects and injuries shows exactly that. Of course, that is if you judge the statistics as you would any other intervention and not set out to dismiss a profession you dislike.
    2. The fact you ignore the evidence does not mean the study has been “refuted” maybe just by yourself for obvious reasons.
    3. See no. 2
    4. Chiropractic is as much evidence-based as many other healthcare professions. If you want to, I can provide ample examples.
    5. The WFC is indeed a pro-chiropractic lobby and every publication should be scrutinized just like your anti-chiropractic lobby.

    And to the point. It is clear that cx SMT does not take a healthy, uncompromised blood vessel and cause dissection. That still does not dismiss responsibility from the chiropractic profession. My reading of the literature and studying different cases in depth is that the SMT probably aggravates the pre-existing or even sub-clinical condition or dislodges a thrombus causing an ischemic CVA.

  • “And to the point. It is clear that cx SMT does not take a healthy, uncompromised blood vessel and cause dissection. That still does not dismiss responsibility from the chiropractic profession.”

    Nice to know – a shame there is a case of chiropractor giving evidence to a court that using a ‘drop technique’ on an elderly patient who has already had surgery for ankylosing spondylosis is acceptable!

    “My reading of the literature and studying different cases in depth is that the SMT probably aggravates the pre-existing or even sub-clinical condition or dislodges a thrombus causing an ischemic CVA.”

    Yup! And so is using the ‘drop technique’ acceptable in a patient with a stiff spine?

  • I personally believe that there are many more cervical artery dissections than are being reported. How many doctors treating a patient having a stroke ask if the patient has visited a chiropractor in the last week?
    Years and years ago when I would visit a chiropractor I WOULD NEVER EVER LET THEM CRACK MY NECK!!!!! I’m no Albert Einstein, but it doesn’t take a genius to figure out that the high velocity adjustments chiropractors do is scary. There are so many bones and blood vessels and nerves in the neck that whatever negligible benefit neck adjustments might give, the risk just wasn’t worth it to me. I am a skeptic. I never believe things that are just told to me without doing my own research and then making a thoughtful and measured decision.
    I have met more chiropractor shysters that you can imagine. What really put me over the edge on Chiropractors was a large sign I saw on the window of a very popular local chiropractior. Guess what this nimrod was claiming that chiropractic could help? Bedwetting, earaches, ADHD, Autism, learning disorders, and some other outrageous claims. I cannot tell you how angry this made me. How anyone could claim to be able to help these issues is outright deception and theft. Here is another opprobrious true story: A young women who is a close friend to our daughter has had 6 miscarriages. She is going to a chiropractor now because he told her he could help her from losing another baby. I love this young woman and the fact that this chiropractor is profiting from their personal tragedy is outrageous.

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