Carotid Artery Dissection and Ischemic Stroke Following Cervical Chiropractic Manipulation: Two Case Reports

Objective Patients can be at risk of carotid artery dissection and ischemic stroke after cervical chiropractic manipulation. However, such risks are rarely reported and raising awareness can increase the safety of chiropractic manipulations. Case Report We present two middle-aged patients with carotid artery dissection leading to ischemic stroke after receiving chiropractic manipulation in Foshan, Guangdong Province, China. Both patients had new-onset pain in their necks after receiving chiropractic manipulations. Excess physical force during chiropractic manipulation may present a risk to patients. Patient was administered with recombinant tissue plasminogen activator after radiological diagnoses. They were prescribed 100 mg and clopidogrel 75 mg daily for 3 months as dual antiplatelet therapy. There were no complications over the follow-up period. Conclusion These cases suggest that dissection of the carotid artery can occur as the result of chiropractic manipulations. Patients should be diagnosed and treated early to achieve positive outcomes. The safety of chiropractic manipulations should be increased by raising awareness about the potential risks.

Femoral Shaft Fracture Occurring as a Result of Physical Manipulation: A Case Report

Treatments including physical manipulation maneuvers have been widely used for the management of various pain complaints. These maneuvers, although generally considered safe, can be associated with serious complications. We report the case of a 37-years-old previously healthy male patient, who presented to our emergency department (ED) for severe right thigh pain and inability to bear weight that developed during a chiropractic session. Imaging done at the ED showed a displaced distal femoral shaft fracture. The majority of the complications of manipulation maneuvers can be as simple as sprains, however, can be drastic or life-threatening in certain cases causing cerebrovascular accidents or major orthopedic fractures. Such complications are rare and definitely underreported. A femoral shaft fracture occurring as a result of physical manipulation has not been previously reported in the literature. We report a distal femoral shaft fracture that was induced by forceful chiropractic manipulation. It is the first to be reported in the literature. This complication should be noted, reported, and the necessary precautions are taken to avoid such major adverse events.

Acute Subdural Hemorrhage as the Initial Presentation of Intracranial Hypotension Following Cervical Chiropractic Manipulation: A Case Report and Systematic Review

Spontaneous intracranial hypotension (SIH) still remains an underdiagnosed etiology of new-onset headache. Important risk factors include chiropractic manipulation (CM). We present a case of a 36-year-old Filipino woman who presented with severe bifrontal and postural headache associated with dizziness, vomiting, and doubling of vision. A cranial computed tomography scan was done which showed an acute subdural hematoma (SDH) at the interhemispheric area. Pain medications were given which afforded minimal relief. On history, the headaches occurred 2 weeks after cervical CM. Cranial and cervical magnetic resonance imaging revealed findings supportive of intracranial hypotension and neck trauma, respectively. The patient improved with conservative management. We found 12 articles on SIH and CM after a systematic review of literature. Eleven patients (90.9%) initially presented with orthostatic headache. Eight patients (66.7%) were initially treated conservatively but only 5 (62.5%) had complete recovery. Recovery was achieved within 14 days from start of supportive therapy. Among the 3 patients who failed conservative treatment, 2 underwent non-directed epidural blood patch and one required neurosurgical intervention. This report highlights that a thorough history is warranted in patients with new onset headache. A history of CM must be actively sought. The limited evidence from the case reports showed that patients with SIH and SDH but with normal neurologic examination and minor spinal pathology can be managed conservatively for less than 2 weeks. This review showed that conservative treatment in a closely monitored environment may be an appropriate first line treatment.

Chiropractic Care for Spine Conditions: Analysis of National Health Interview Survey

Objective: To estimate the use of chiropractic care and perceived value for spinal conditions. Methods: National Health Interview Survey (NHIS) data from the Sample Adult for 1997, 2002, 2007 and 2012 and the Adult Alternative Medicine for 2002, 2007, and 2012 files were analyzed. National Population Estimates (NPE) was generated by applying the complete survey design structure. Odds ratios (OR) and 95% confidence intervals (CI) were generated to explore the likelihood that the respondents reporting spine-related problems would see Doctors of Chiropractic (DC) or other providers compared to those reporting no spine-related problems. Results: Reported use of chiropractic increased from 7.61% in 1997 to 10.11% in 2012 (p-value<0.001); the NPE increased by 8,023,162 adults. The OR of seeing a DC among those with the spine-related complaint was significantly higher (ranging over time from 4.31 to 3.09) than other providers, except in 2012 in which physical therapists were highest. For respondents reporting spine-related complaints, the OR was 2.40 (95%CI=1.28-4.50) for using chiropractic compared to osteopathic manipulation. Respondents with spine-related conditions were more likely to have a DC as their personal healthcare provider [OR(95%CI=3.48(2.60-4.65)]. Over 96% of those who did reported that it helped and were less likely to report using prescription medication [OR(95%CI) = 0.44(0.35-0.55)], over-the-counter medication [OR(95%CI) = 0.80(0.65-0.99)], surgery [OR(95%CI) = 0.35(0.23-0.52)], or physical therapy [OR(95%CI)=0.50(0.40-0.63)]. They were less likely to report receiving a recommendation from a medical doctor to seek chiropractic manipulation [n=224 (19.15%); OR(95%CI=0.49(0.39-0.62)]. Conclusion: The general use of chiropractic in the United States is slowly increasing but utilization is still low compared to that of primary care providers like MDs and NPs. A majority of NHIS 2012 respondents with spine-related problems used chiropractic manipulation for treatment and those who did were more likely to report that it helped and less likely to report using prescription and over-the-counter medications, surgery or physical therapy. Yet chiropractic care was hardly being recommended by medical doctors.