• Nunn NR
• Battiston A
• Harrison J

• Manipulation, Cervical
• Open Access Document
• Vertebral Artery Dissection

Background: his paper aims to provide evidence and the importance of obtaining consent by reviewing the association between cervical spinal adjustments or manipulation (CeSAM) and cervical vascular accidents (CeVA) in patients presenting with headaches and neck pain, considering the Montgomery ruling in the UK. Thus, informed consent is obtained, and patients can decide whether to proceed with care or treatment.

Intervention: Reviewing factors in a patient’s history, including past medical history, family medical history, and medication, considering both modifiable and non-modifiable risk factors associated with cervical vascular accidents (CeVAs), and performing a neurovascular examination to mitigate the risk of CeVAs associated with cervical spine adjustments. It links other relevant activities and professions to CeVA, which are recorded in peer-reviewed papers that place less emphasis. 

Outcome: A summary of the most common risk factors directly linked to cervical vascular accidents. It presents three cases recorded at the educational institution, which were considered as potential cervical vascular accidents (CeVAs), with their subsequent management. This supports a positive view showing that Chiropractors screen for potential CeVA and refer accordingly.

Conclusion: Cervical artery dissection is the most serious recorded iatrogenic complication associated with cervical spinal adjustments or manipulation. Currently, the evidence is weak for an association between CeSAM and CeVA, and the available data suggest no causal effect from CeSAM. With the change in law and the introduction of the Montgomery ruling in 2015, it is imperative to recognise that a direct or indirect association or causal link between chiropractic adjustments and CeVA is no longer relevant.

It is essential to explain to the patient that ‘We have taken a detailed history and recorded modifiable and non-modifiable risks, medications, past medical history, and family history, along with neurovascular examination, which are all within normal limits. From the history and examination, the signs and symptoms you have presented are musculoskeletal. However, we must make you aware that these signs and symptoms are also a presentation for an increased risk of a cervical vascular dissection or stroke and may be exacerbated by the adjustment, manipulation, or any cervical joint treatment. The positive is that treating the presenting signs and symptoms should give you the relief you want’. 

According to peer-reviewed literature, Chiropractic adjustments are still associated with a risk factor. However, is this a balanced view? Many articles report the most serious adverse effects, but few report the positive impact of appropriate referral. This paper covers three such cases. We encourage those who have used the neurovascular screening criteria, identified a potential CeVA, and made the appropriate referral to the hospital to document their experiences, providing a balance to the discussion.

Indexing terms: Cervical vascular accident; carotid artery accident; vertebral artery accident; cervical chiropractic adjustments; osteopathic manipulation; physiotherapy manipulation; CVA.

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