Latest Research: Chiropractic manipulation of the spine may cause strokes and even death

Anybody who has been hanging out in the skeptic landscape knows about Chiropractors vs Simon Singh.

For those that don’t here is a brief summary … Simon Singh, the UK based science writer wrote an article – “Beware the Spinal Trap” in which he was critical of the practice of chiropractors. Basically … bad back perhaps, but for some wacky ideas such as treating childhood colic, bed-wetting, ear infections or asthma, nope not a jot of evidence. The British Chiropractic Association sued. When a ruling went against the BCA they backed off and withdrew the case. For them it was  worse than any Streisand effect, it generated  formal complaints against one-quarter of all British chiropractors.

In an effort to try and repair this PR disaster the General Chiropractic Council disowned the claims of the BCA–the same claims that lie at the centre of its libel action against Simon Singh.

So all is well now and they don’t tout wacky claims but instead only treat back pain? … perhaps not.

In the Guardian yesterday, professor Edzard Ernst writes a fascinating article.

As a quick aside … who is Professor Ernst? Well, he is a researcher specializing in the study of complementary and alternative medicine. Ernst was appointed Professor of Complementary Medicine at the University of Exeter, the first such academic position in the world … don’t panic, he is not a woo-practitioner, but is with us and takes an evidence based approach. He spent all his time in that role testing it all and has a long list of stuff that he has proven via studies to not work.

He wrote a great book in conjunction with Simon Singh entitled Trick or Treatment. It does a great job of debunking a lot of woo, so you should check it out and add it to your skeptic collection.

He is also a very nice chap, and is the only person I know who can wow a room packed with 400 skeptics while wearing red trousers.

So anyway, he writes a really interesting article about a recent study by American neurosurgeons that adds to the evidence suggesting chiropractic manipulation can damage arteries supplying the brain

Well over 500 cases have been documented where a patient has suffered a stroke after getting his or her neck manipulated and many have died subsequently. What seems to happen is that certain manipulations carried out by chiropractors – particularly those that involve forceful rotation of the neck to one side – may over-stretch an artery that runs along the spine. If that happens this vessel can dissect or disintegrate, resulting in a blockage of blood flow to the brain, ie. a stroke.

You might be wondering about getting a ref to the peer-reviewed article he is writing about, well here you go …

Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management.

RESULTS:

Thirteen patients (8 women and 5 men, mean age 44 years, range 30-73 years) presented with neurological deficits, head and neck pain, or both, typically within hours or days of chiropractic manipulation. Arterial dissections were identified along the entire course of the vertebral artery, including the origin through the V(4) segment. Three patients had vertebral artery dissections that continued rostrally to involve the basilar artery. Two patients had dissections of the internal carotid artery (ICA): 1 involved the cervical ICA and 1 involved the petrocavernous ICA. Stenting was performed in 5 cases, and thrombolysis of the basilar artery was performed in 1 case. Three patients underwent emergency cerebellar decompression because of impending herniation. Six patients were treated with medication alone, including either anticoagulation or antiplatelet therapy. Clinical follow-up was obtained in all patients (mean 19 months). Three patients had permanent neurological deficits, and 1 died of a massive cerebellar stroke. The remaining 9 patients recovered completely. Of the 12 patients who survived, radiographic follow-up was obtained in all but 1 of the most recently treated patients (mean 12 months). All stents were widely patent at follow-up.

CONCLUSIONS:

Chiropractic manipulation of the cervical spine can produce dissections involving the cervical and cranial segments of the vertebral and carotid arteries. These injuries can be severe, requiring endovascular stenting and cranial surgery. In this patient series, a significant percentage (31%, 4/13) of patients were left permanently disabled or died as a result of their arterial injuries.

The conclusion from the above study says it all … prior to this I used to think that while the basis for manipulating the spine to cure back pain was batty, (the belief that the spine and health are related in a fundamental way), I also thought that it would not cause any real harm. This latest study has changed my mind.

If you challenge the Chiropractors about this, they then quote this 2010 study at you …

Risk of Vertebrobasilar Stroke and Chiropractic Care – the abstract reads – “There was no increased association between chiropractic visits and VBA stroke in those older than 45 years“

Yep, they are rather fond of touting that. The problem is that if you read just the abstract you get the wrong impression, what you need to do is to read that actual study. If you do, then you find that it does not support their claims at all. So even the paper that the Chiropractors cite to support their assertion that spinal manipulation is safe says no such thing, Table 3 inside that paper is the smoking gun..… a population that should not have a stroke, the young, has a marked increase association with stroke 24 hours after visiting a chiropractor. All this latest study does is to add additional evidence to that.