x Cervical artery dissections happen; this doesn’t mean you need to avoid going to your chiropractor. x This doesn’t mean it was caused by the chiropractor. x It does mean anyone with neck pain needs to fully advise their chiropractor of any other symptoms or problems they are having with the neck pain. The Take-Aways 1. The family of Ms. May are naturally upset about the loss of a loved one. They are entitled to their emotional grief, and if they may choose to direct it toward our profession. There is nothing to be gained by engaging them in a discussion while they are in their emotional state. 2. Have the data cited on The Dr. Oz Show from chiropractic education in mind when you speak with patients about these matters: a. Life University, 25 years, 4.5 million cervical adjustments — no dissection related issues have been reported b. Among all 17 chiropractic educational institutions, 20 years, millions of cervical adjustments — no dissection related issues have been reported c. The 25-year window at LIFE and the 20-year window across chiropractic education should not imply something happened 26 or 21 years ago, respectively. The data isn’t available for the period before those dates. 3. Patients will want to chat about the 5 Ds, 3 Ns and the A a. Dysphagia, dysarthria, diplopia, drop attacks and nystagmus are important symptoms that, by themselves in the presence of neck pain, strongly suggest referral. b. Dizziness, nausea, numbness and ataxia are not as strongly associated by themselves with dissection and stroke, but you should look for the development of these symptoms in a constellation as a guide to increasing your index of suspicion. c. When patients present saying that my neck pain is “unlike any pain I ever had before in my life” or “the most unusual pain I have ever had” or “the worst pain I have ever had,” THINK about the possibility of a dissection in progress and handle accordingly. 4. Chiropractic care is very safe. When it is viewed in a comparative sense with pharmaceuticals or surgery for similar types of problems, it is remarkably safe. Life has risks. There are fewer risks under chiropractic care than under medical or surgical care. 5. This wasn’t discussed on The Dr. Oz Show, but it is something you should be aware of: Th e Coroner’s Report in the case of Ms. May noted: “Bilateral vertebral artery dissection is a rare complication of neck manipulation in one per 100,000 to one in 2 million manipulations. (South Med J. 2007 Feb; 100(2):201- 3)” a. The literature cited is misquoted as follows: 1. The article states “Serious complications are infrequent, with a reported incidence between one per 100,000 and one per 2 million manipulations.” 1. This does not refer exclusively to vertebral artery complications. 2. This does not refer to bilateral vertebral artery dissection. b. The literature cited did not identify an arterial dissection-unilateral or bilateral on imaging or during autopsy. c. The literature cited was the weakest class of evidence, a single case study, and neglected the opportunity to refer to two more recent case-control and case- crossover studies (Cassidy, 2008) and Kosloff (2015). He also chose not to refer to a recent meta-analysis on this subject conducted by neurosurgeons at Penn State Hershey Medical Center (Church, 2016).
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