Spinal manipulation is usually performed by a therapist (chiropractor, osteopath, physiotherpist, doctor, etc.). But many people do it themselves. Self-manipulation is by no means safer than the treatment by a therapist, it seems. We have previously seen cases where the results were dramatic:
- Spinal epidural haematoma after neck manipulation (edzardernst.com)
- A ‘Self-Chiropractic Spinal Manipulation’ that resulted in death (edzardernst.com)
Now, a further case has been reported. In this paper, American pathologists present a tragic case of fatal vertebral artery dissection that occurred as the result of self-manipulation of the cervical spine.
The decedent was a 40-year-old man with no significant past medical history. He was observed to “crack his neck” while at work. Soon after, he began experiencing neck pain, then developed stroke-like symptoms and became unresponsive. He was transported to a local medical center, where imaging showed bilateral vertebral artery dissection. His neurological status continued to decline, and brain death was pronounced several days later.
An autopsy examination showed evidence of cerebellar and brainstem infarcts, herniation, and diffuse hypoxic-ischemic injury. A posterior neck dissection was performed to expose the vertebral arteries, which showed grossly visible hemorrhage and dilation. There was no evidence of traumatic injury to the bone or soft tissue of the head or neck. Bilateral dissection tracts were readily appreciated on microscopic examination. Death was attributed to self-manipulation of the neck, which in turn led to bilateral vertebral artery dissection, cerebellar and brainstem infarcts, herniation, hypoxic-ischemic injury, and ultimately brain death.
It seems clear to me that only few and spectacular cases of this nature are being published. In other words, the under-reporting of adverse effects of self-manipulation must be close to 100%. It follows that the risk of sel-manipulation is impossible to quantify. I suspect it is substancial. In any case, the precautionary principle compells me to re-issue my warning:
do not allow anybody to manipulate your neck, not even yourself!
4 Responses to Fatal Vertebral Artery Dissection Following Self-Manipulation of the Cervical Spine
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A few things spring to mind;
If, a big and negative if, a god existed, really stupid design,
Chiros know nothing about anatomy,
Chiro is all about making money,
Misinformation is rife,
Most people are stupid.
It seems highly likely that chiropractors will either (a) ignore this report, withholding comment, or (b) distance their “profession” from any culpability, because the harm was self-inflicted by an “amateur.”
I would say the man mostly likely had an undiagnosed medical condition.
I once spoke with a chiropractor who would not touch necks, because she said the incidence of major or crippling effects was just too high (she knew of about 20 cases that had become wheelchair-bound due to neck “manipulation”, and this was back ca. 1980).