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DOI: 10.1055/s-0028-1109083
© Georg Thieme Verlag KG Stuttgart · New York
Manipulationsbehandlung der HWS und Schlaganfall[*]
Manipulative Treatment of the Cervical Spine and StrokePublication History
Publication Date:
16 February 2009 (online)

Zusammenfassung
Die Manipulationsbehandlung der HWS trägt ein messbares Risiko, einen ischämischen Schlaganfall auszulösen. Wir analysierten alle zwischen 1996 und 2005 der Schlichtungsstelle für Arzthaftpflichtfragen der Norddeutschen Ärztekammern vorgelegten Karotis- und Vertebralisdissektionen, in denen ein Schuldvorwurf wegen einer manipulativen Behandlung der HWS erhoben wurde. In keiner der 7 Karotis- und 9 Vertebralisdissektionen konnte eine Verursachung durch die Manipulation bestätigt werden. Vielmehr lagen bei 5 der Karotis- und 7 der Vertebralisfälle entweder klare Beweise oder zumindest eine sehr hohe Wahrscheinlichkeit vor, dass die Dissektion vor der Manipulation bestand. Als besonders hinweisend wurden vorangehende neurologische Symptome und eine unmittelbare Auslösung des Schlaganfalls durch die Manipulation gewertet. Ursache der Schlaganfälle waren Embolisationen thrombotischen Materials aus den Dissekaten. Da Dissektionen Nackenschmerzen und zervikale Blockaden verursachen, die denen eines unspezifischen Zervikalsyndroms gleichen, ist eine neurologische Abklärung vor jeder manipulativen Behandlung unerlässlich. Die klinischen und medico-legalen Aspekte werden diskutiert.
Abstract
Manipulative therapy of the cervical spine is associated with a considerable risk of stroke. We evaluated all cases with the diagnosis of arterial dissection submitted between 1996 and 2005 to the Schlichtungsstelle für Arzthaftpflichtfragen der Norddeutschen Ärztekammern for assessment of the accusations brought against the therapists who conducted the manipulation. Neither in the 7 carotid nor in the 9 vertebral artery cases could a causal link be made between the dissection and the manipulation. However, in 5 of the 7 carotid and 7 of the 9 vertebral artery dissections there was clear evidence or high probability that the dissection was present prior to the manipulation, and had caused neck pain, segmental dysfunction and, in some cases, even neurological symptoms. Stroke after manipulative therapy was due to embolisation of thrombotic material from the dissected artery. As both cervical arterial dissection and cervical spine disorder usually cause similar signs and symptoms physicians must differentiate between these two entities prior to any manipulative therapy. Clinical indicators of pre-existent dissection and the medicolegal implications are discussed in this paper.
Schlüsselwörter
Chirotherapie - HWS-Manipulation - Hirninfarkt - Schlaganfall - Karotisdissektion - Vertebralisdissektion
Key words
chirotherapy - cervical spine manipulation - stroke - carotid dissection - vertebral artery dissection
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1 * Erstveröffentlichung in MedSach 2008; 104 (5): 174–181.
Prof. Dr. Peter Marx
Terrassenstr. 45
14129 Berlin
Email: peter.marx@charite.de