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Manual Spinal Care and a Relationship, If Any, to Cervical Arterial Dissection

Over the past several decades the question of a possible relationship between manual care of the cervical spine and the occurrence of artery dissection, most notably, vertebral artery dissection has been discussed in case reports and case series in the scientific literature. While researchers are still investigating this question, the reality is that the number of malpractice stroke claims has significantly increased in the past few years. As a chiropractor, it is critical that you protect yourself and your practice from stroke claims. The two most important things that you can do in order to protect yourself are: 1) Implement an Informed Consent Process that includes having all patients sign an Informed Consent that warns of the risk of stroke and 2) Be able to recognize potential stroke symptoms. In many claims that we’ve seen, patients and attorneys are concluding that simply because a patient had chiropractic treatment and also had a stroke, the chiropractic treatment caused the stroke. Many of these claims are frivolous. Population studies demonstrate no greater likelihood of a person presenting for health care to their primary medical provider or their chiropractor with neck pain and/or headache developing a stroke. Therefore the issue is the patient’s circumstance not what was done to the patient. You quite reasonably might ask “If this is the case why are we continuing to hear about this situation being related to chiropractic care?” First, arterial dissection and a related stroke are very important events and have the potential of causing long-term disability and death. If there is anything we can do to minimize this potential we must educate ourselves and be alert to how we can help avoid this problem. Second, this type of arterial dissection, and the stroke associated with it, represents a significant portion of strokes in persons from 25-40 years of age. These are not end-of-life events occurring in the final years of life, rather they are occurring in the prime of life and while all strokes deserve our attention, these even more so. Third, in the simple equation for the consumer is: this is a problem in the neck, we do something to the neck, if this follows something we did, we must have caused it. The fact that the situation is far more complex and nuanced is lost on much of the public. Fourth, this is a very rare occurrence and when it does occur it garners a good bit of attention. We need to understand, appreciate and be aware of matters related to this clinical area at a higher level than any once else in health care. This allows us to be more suspicious of presenting symptoms with this condition in our minds, it allows us to provide current, accurate and evidence-based information to patients, other providers and the media when necessary.

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