Death following chiropractic neck manipulation, a rare event?

The aim of this study was to review the deaths associated with chiropractic treatment in Australia. The National Coronial Information System (NCIS) was searched for cases in Australia for which chiropractic treatment was determined to have contributed to death. Closed, completed Australian cases between 1 July 2000 and 31 December 2019 were evaluated (approximately 356,000 cases).

The findings revealed only one case in which chiropractic treatment was considered to have contributed to death. The case was that of an adult male who died from a dissected left vertebral artery following chiropractic manipulation for neck pain.

In addition, postmortem records at Forensic Science SA (FSSA) were searched for similar cases over the same time period (approximately 30,000 cases). No cases definitely attributable to chiropractic manipulation of the neck were found, but a case with thrombus in the left vertebral artery would not be entirely excluded as being related to chiropractic treatment.

Deaths associated with chiropractic manipulation in Australia therefore appear rare. Although there is a reported incidence of stroke associated with vertebrobasilar artery system occlusion following chiropractic manipulation, stroke associated with vertebrobasilar artery occlusion has also been observed following a visit to a primary care physician. This could be explained by vertebrobasilar artery pathology causing neck pain that initiated consultation.

The authors concluded that the present study only demonstrates a rare temporal, but not causal, relationship between attending a chiropractor and vertebral artery dissection causing death. Non-lethal injuries were not assessed.

This is an interesting paper. Many chiropractors steadfastly deny that their manipulations can cause serious problems. This analysis clearly shows that this assumption is untrue. It also suggests that deaths are rare. The question is: how reliable is this conclusion?

The authors searched NCIS and the FSSA for cases for which chiropractic treatment was determined to have contributed to death. In other words, fatalities for which chiropractic treatment had not been determined to have contributed to death were not considered. Because the link between a person’s death and a spinal manipulation might often not be made, further cases of deaths might need to be added to the total.

A further question is this: even if – as we all hope – deaths are very rare, does that mean chiropractic manipulations are safe? Here the answer is clearly NO! Death is merely the most dramatic outcome. Spinal manipulations can cause strokes, and most of these events do result in neurological deficits but not death.

Finally, we need to consider the risk/benefit balance of chiropractic manipulations. As often discussed here, the benefits of spinal manipulation are, depending on the indication, small or uncertain. This means that even rare but serious adverse events weigh heavily and tilt the balance into the negative. In short, this means that chiropractors should be avoided.

In conclusion, this paper leaves no doubt that chiropractic manipulations can be deadly. One would very much hope that such fatalities are extremely rare events, however, the data provided are not convincing.