Trends in Vertebral Artery Dissection as a Result of Chiropractic Cervical Manipulation

Introduction: Chiropractic cervical manipulation is a well-documented initiator of vertebral artery dissection (VAD). The rate of VAD reports in the literature has been increasing in recent decades. Yet, the rate by which individuals are visiting chiropractors is either decreasing or stagnant. We examined whether a similar increasing trend is seen in reports of chiropractic induced VAD and how these events are reported in the literature.

Methods: Analysis of reported cases from Pubmed, Google, and Scopus databases.

Results: Reports of vertebral artery dissection were 9.5-fold greater in 2012 than in 1990. This growth is the result of a sustained increasing trend. VAD attributed to chiropractic neck manipulation was found in 54 original publications between 1956 and 2011. Reporting on this topic is not increasing. Nearly 28% (15) of the articles were published between 2000 and 2004; 50% (27) were reported between 1995 and 2004. A decline to historic levels was observed after 2004. Journal subjects include Neurology (17), Medicine (13), Radiology (7), Surgery (7), Otolaryngology (2), and Chiropractic (2).

Conclusions: Despite the increase in number of VAD reported in literature, the number of VAD attributed to chiropractor manipulation has decreased. The diverging trends indicate that increasing vertebral artery dissections may not be due to chiropractor manipulation.