Assessing the Risk of Stroke from Neck Manipulation: A Systematic Review.
Written by Editor   
Wednesday, April 30, 2014 11:55 AM

Strokes, typically involving vertebral artery dissection, can follow cervical spinal manipulative therapy, and these types of stroke occur rarely. There is disagreement about whether a strong association between neck manipulation and stroke exists, but conclusive evidence is lacking for a strong association between neck manipulation and stroke.

PRISMA guidelines for systematic reviews were followed, and the literature was searched using a strategy that included the terms 'neck manipulation' and 'stroke' from the PubMed, Embase, CINAHL Plus and AMED databases. Citations were included if they met criteria such as being case-control studies, and dealt with neck manipulation and/or neck movement/positioning. Papers were scored for their quality, using similar criteria to the earlier review. For individual criteria, each study was assigned a full positive score if the criterion was satisfied completely.

Four case-control studies and one case-control study, which included a case- crossover design, met the selection criteria, but all of them had at least three items in the quality assessment that failed to be completely positive. Two studies were assessed to be the most robustly designed, however, potential biases and confounders render the results inconclusive.

But conclusive evidence is also absent for no association between neck manipulation and stroke.