S182 Spine • Volume 33 • Number 4S • 2008
nately, there is no acceptable screening procedure to identify patients with neck pain at risk of VBA stroke. 37 These events are so rare and difficult to diagnose that future studies would need to be multicentered and have unbiased ascertainment of all potential exposures. Given our current state of knowledge, the decision of how to treat patients with neck pain and/or headache should be driven by effectiveness and patient preference. 38 Conclusion Our population-based case-control and case-crossover study shows an association between chiropractic visits and VBA strokes. However, we found a similar associa- tion between primary care physician visits and VBA stroke. This suggests that patients with undiagnosed ver- tebral artery dissection are seeking clinical care for head- ache and neck pain before having a VBA stroke. Key Points ● Vertebrobasilar artery stroke is a rare event in the population. ● There is an association between vertebrobasilar artery stroke and chiropractic visits in those under 45 years of age. ● There is also an association between vertebro- basilar artery stroke and use of primary care phy- sician visits in all age groups. ● We found no evidence of excess risk of VBA stroke associated chiropractic care. ● The increased risks of vertebrobasilar artery stroke associated with chiropractic and physician visits is likely explained by patients with vertebro- basilar dissection-related neck pain and headache consulting both chiropractors and primary care physicians before their VBA stroke. Acknowledgments The authors acknowledge the members of the Decade of the Bone and Joint 2000 –2010 Task Force on Neck Pain and its Associate Disorders for advice about de- signing this study. In particular, they acknowledge the help of Drs. Hal Morgenstern, Eric Hurwitz, Scott Haldeman, Linda Carroll, Gabrielle van der Velde, Lena Holm, Paul Peloso, Margareta Nordin, Jaime Guzman, Eugene Carragee, Rachid Salmi, Alexander Grier, and Mr. Jon Schubert. References 1. Borghouts JA, Koes BW, Vondeling H, et al. Cost-of-illness of neck pain in The Netherlands in 1996. Pain 1999;80:629–36. 2. Coˆte´ P, Cassidy JD, Carroll L. The Saskatchewan Health and Back Pain Survey. The prevalence of neck pain and related disability in Saskatchewan adults. Spine 1998;23:1689–98. 3. Coˆte´ P, Cassidy JD, Carroll L. The factors associated with neck pain and its related disability in the Saskatchewan population. Spine 2000;25:1109–17. 4. Coˆte´ P, Cassidy JD, Carroll L. Is a lifetime history of neck injury in a traffic collision associated with prevalent neck pain, headache and depressive symp- tomatology? Accid Anal Prev 2000;32:151–9.
5. Coˆte´ P, Cassidy JD, Carroll LJ, et al. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain 2004; 112:267–73. 6. Coˆte´ P, Cassidy JD, Carroll L. The treatment of neck and low back pain: who seeks care? who goes where? Med Care 2001;39:956–67. 7. Hurwitz EL, Coulter ID, Adams AH, et al. Use of chiropractic services from 1985 through 1991 in the United States and Canada. Am J Public Health 1998;88:771–6. 8. Hurwitz EL, Chiang LM. A comparative analysis of chiropractic and general practitioner patients in North America: findings from the joint Canada/United States Survey of Health, 2002–03. BMC Health Serv Res 2006;6:49. 9. Aker PD, Gross AR, Goldsmith CH, et al. Conservative management of mechanical neck pain: systematic overview and meta-analysis. BMJ 1996; 313:1291–6. 10. Gross AR, Kay T, Hondras M, et al. Manual therapy for mechanical neck disorders: a systematic review. Man Ther 2002;7:131–49. 11. Hurwitz EL, Aker PD, Adams AH, et al. Manipulation and mobilization of the cervical spine. A systematic review of the literature. Spine 1996;21: 1746–59. 12. McClune T, Burton AK, Waddell G. Whiplash associated disorders: a review of the literature to guide patient information and advice. Emerg Med J 2002;19:499–506. 13. Peeters GG, Verhagen AP, de Bie RA, et al. The efficacy of conservative treatment in patients with whiplash injury: a systematic review of clinical trials. Spine 2001;26:E64–E73. 14. Norris JW, Beletsky V, Nadareishvili ZG. Sudden neck movement and cer- vical artery dissection. The Canadian Stroke Consortium. CMAJ 2000;163: 38–40. 15. Ernst E. Manipulation of the cervical spine: a systematic review of case reports of serious adverse events, 1995–2001. Med J Aust 2002;176:376–80. 16. Haldeman S, Kohlbeck FJ, McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine 1999;24:785–94. 17. Rubinstein SM, Peerdeman SM, van Tulder MW, et al. A systematic review of the risk factors for cervical artery dissection. Stroke 2005;36:1575–80. 18. Inamasu J, Guiot BH. Iatrogenic vertebral artery injury. Acta Neurol Scand 2005;112:349–57. 19. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001;344:898–906. 20. D’Anglejan-Chatillon J, Ribeiro V, Mas JL, et al. Migraine—a risk factor for dissection of cervical arteries. Headache 1989;29:560–1. 21. Pezzini A, Caso V, Zanferrari C, et al. Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study. J Neurol Neu- rosurg Psychiatry 2006;77:95–7. 22. Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med 2005;352: 2618–26. 23. Lee VH, Brown RD Jr, Mandrekar JN, et al. Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006;67: 1809–12. 24. Rothwell DM, Bondy SJ, Williams JI. Chiropractic manipulation and stroke: a population-based case-control study. Stroke 2001;32:1054–60. 25. SmithWS, Johnston SC, Skalabrin EJ, et al. Spinal manipulative therapy is an independent risk factor for vertebral artery dissection. Neurology 2003;60: 1424–8. 26. Arnold M, Bousser MG, Fahrni G, et al. Vertebral artery dissection: present- ing findings and predictors of outcome. Stroke 2006;37:2499–503. 27. Maclure M. The case-crossover design: a method for studying transient ef- fects on the risk of acute events. Am J Epidemiol 1991;133:144–53. 28. Kelman CW, Kortt MA, Becker NG, et al. Deep vein thrombosis and air travel: record linkage study. BMJ 2003;327:1072. 29. MittlemanMA, Maclure M, Tofler GH, et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regu- lar exertion. Determinants of Myocardial Infarction Onset Study Investiga- tors. N Engl J Med 1993;329:1677–83. 30. Redelmeier DA, Tibshirani RJ. Association between cellular-telephone calls and motor vehicle collisions. N Engl J Med 1997;336:453–8. 31. Janes H, Sheppard L, Lumley T. Overlap bias in the case-crossover design, with application to air pollution exposures. Stat Med 2005;24:285–300. 32. Janes H, Sheppard L, Lumley T. Case-crossover analyses of air pollution exposure data: referent selection strategies and their implications for bias. Epidemiology 2005;16:717–26. 33. Efron B, Tibshirani RJ. An Introduction to the Bootstrap. New York: Chap- man and Hall/CRC, 1993. 34. STATA/SE [computer program]. College Station, Tex: Stata Corp, 2006. 35. Liu L, Reeder B, Shuaib A, et al. Validity of stroke diagnosis on hospital
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