Open Access Original Article
DOI: 10.7759/cureus.498
Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation
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Ephraim W. Church , Emily P. Sieg , Omar Zalatimo , Namath S. Hussain , Michael Glantz , Robert E. Harbaugh 1 1
1. Department of Neurosurgery, Penn State Hershey Medical Center 2. Department of Neurosurgery, Johns Hopkins University School of Medicine
Corresponding author: Ephraim W. Church, echurch@hmc.psu.edu Disclosures can be found in Additional Information at the end of the article
Abstract Background
Case reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD. Methods Search terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria. Results Our search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was "very low." Conclusions The quality of the published literature on the relationship between chiropractic manipulation and CAD is very low. Our analysis shows a small association between chiropractic neck manipulation and cervical artery dissection. This relationship may be explained by the high risk of bias and confounding in the available studies, and in particular by the known association of neck pain with CAD and with chiropractic manipulation. There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.
Received 01/26/2016 Review began 01/28/2016 Review ended 02/08/2016 Published 02/16/2016
© Copyright 2016 Church et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Categories: Neurology, Neurosurgery, Public Health Keywords: vertebral atery dissection, cervical artery dissection, chiropractic manipulation, cervical manipulation, internal carotid artery dissection, cervical spine manipulative therapy
Introduction
How to cite this article Church E W, Sieg E P, Zalatimo O, et al. (February 16, 2016) Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus 8(2): e498. DOI 10.7759/cureus.498
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