Neck manipulations and neck artery dissection

Osteopathy is not a risky business, whatever some professional sceptics may have you believe.   A comprehensive study of available literature, conducted in 2009 found that serious adverse events did occur that were associated with osteopathic treatment but they were very rare.  The most serious of these were strokes associated with damage to the arteries of the neck following an upper neck manipulation.  

Risks of major adverse events, such as stroke with neck manipulation, are very low. Estimates suggest around 1 per 100,000 to 1,000,000 manipulations or 1 per 50,000 to 100,000 patients. To put this in perspective, the risk of having a stroke without a manipulation is around 100 strokes per 100,000 (or 1 per 1,000 people) in the general population in the UK over a one year period.  you can read the study here if you wish.

But that doesn't tell the full story.  Those are serious adverse events associated with neck manipulations but that could be like saying going to the shops makes you fat because you notice that the more often you go to the shops the fatter you get.  Of course it is not shopping that makes you fat, it is eating the chocolate bars you buy at the shop that makes you fat but there is a correlation because if you go out to buy chocolate bars more often and then eat them you both visit the shop more often and get fatter.  

So appears to be the case with neck manipulations and artery damage leading to stroke.  A new review of the literature, read it here finds evidence that the linking variable is likely to be neck pain or headache and that some patients with a dissecting artery present at the therapist with neck pain or headache and are treated but that the neck pain/headache is the true symptom of the dissecting artery and the manipulation has no effect on it.    There is a lovely table at the end of the paper showing Hills criteria for causality which clearly shows on how many counts cervical manipulations fail to qualify as causal for dissecting arteries.

This is good news but is unlikely to change how I practice in the short term.  I will still take a detailed case history so I am aware of the likelihood of any conditions pertinent to my treatment of you and I will still exercise caution in the treatment of anyone at risk of cardiovascular disease or connective tissue disorders or indeed with any anticipated bone weakness.

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