How to reduce the risk of cervical artery dissection occurring during cervical spine

manipulations.

The main concern is ensuring cervical adjustments are performed safely and appropriately to
reduce the risk of dissection occurring to the cervical artery. Due to the location of the cervical
artery and proximity to bony structures it is believed that there is a higher risk of dissection
occurring than in other arteries of comparable size. It is believed that sudden neck movement,
a feature in chiropractic care can be a contributing risk factor for ‘spontaneous’ cervical artery
dissection. It is our job as practitioners to ensure we are informed with the right knowledge
of how to determine the signs, symptoms and onset of ischemic stroke as a result of arterial
dissection.

Utilising manual tests in clinic prior to performing cervical adjustments and gaining a detailed
report of patient history is imperative to reducing the risk of dissection to the patient.
Fortunately, according to Chaibi (2019) states the incidence rate of cervical artery dissection
is relatively low, it is estimated that it occurs in 2.9/100,000 individuals per year. Even with
this rate being so low it is important that practitioners perform the necessary screening prior
to performing cervical adjustments. Currently I believe that my understanding of how to
assess a patient prior to a cervical adjustment could be improved upon, I have learnt
fundamentals however I believe there is room for improvement.

By researching peer reviewed journal articles and learning additional skills through the
chiropractic lecturers is the most informative way for me to learn how to perform cervical
adjustments safely. It is interesting to note that Kennel (2008) study shows a correlation
between stroke occurring in a period of one-month, post cervical adjustment occurring.
Whilst conducting this study there was a similar magnitude if not more cases of
vertebrobasilar stroke occurring post visiting a primary care physician. This suggests that
cervical manipulation by chiropractors poses no more risk with regards to cervical artery
dissection than visits to primary care physicians, such as general practitioners.

Having an integrated team approach is important in order to build upon our knowledge
collectively of practicing chiropractic’s in a safe environment. Creating new relationships with
others in our scope of practice will enable us further our individual understanding and also
come together to create an integrated care approach. I believe that whilst there may be
aspects of chiropractic’s that people may find have an element of risk associated, it is
important that we as practitioners educate people on how we limit the associated risk whilst
imparting a positive outlook on the effectiveness of how we practice.

References:

Kennell, K., Daghfal, M., Patel, S., DeSanto, J., Waterman, G., & Bertino, R. (2017). Cervical
artery dissection related to chiropractic manipulation: One institution's experience. The
Journal of Family Practice, 66(9), 556-562.

Aleksander Chaibi & Michael Bjørn Russell (2019) A risk–benefit assessment strategy to
exclude cervical artery dissection in spinal manual-therapy: a comprehensive review, Annals
of Medicine, 51:2, 118-127, DOI: 10.1080/07853890.2019.1590627