Index to Chiropractic Literature
Index to Chiropractic Literature
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Thursday, July 18, 2019
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ID 24796
Title Systematic review and meta-analysis of chiropractic care and cervical artery dissection: No evidence for causation [systematic review]
URL https://vertebralsubluxation.sharepoint.com/Pages/2016_1435_cervicalarterydissection.aspx
Journal Ann Vert Sublux Res. 2016 Spring;2016(2):Online access only p 45-52
Author(s)
Subject(s)
Peer Review Yes
Publication Type Systematic Review
Abstract/Notes

Background: Case reports and case control studies have suggested an association between chiropractic neck manipulation and cervical artery dissection (CAD), but a causal relationship has not been established. We evaluated the evidence related to this topic by performing a systematic review and meta-analysis of published data on chiropractic manipulation and CAD.

Methods: Search terms were entered into standard search engines in a systematic fashion. The articles were reviewed by study authors, graded independently for class of evidence, and combined in a meta-analysis. The total body of evidence was evaluated according to GRADE criteria.

Results: Our search yielded 253 articles. We identified two class II and four class III studies. There were no discrepancies among article ratings (i.e., kappa=1). The meta-analysis revealed a small association between chiropractic care and dissection (OR 1.74, 95% CI 1.26-2.41). The quality of the body of evidence according to GRADE criteria was "very low."

Conclusions: The quality of the published literature on the relationship between chiropractic manipulation and CAD is very low. Our analysis shows a small association between chiropractic neck manipulation and cervical artery dissection. This relationship may be explained by the high risk of bias and confounding in the available studies, and in particular by the known association of neck pain with CAD and with chiropractic manipulation. There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.

Author keywords: vertebral artery dissection, cervical artery dissection, chiropractic manipulation, cervical manipulation, internal carotid artery dissection, cervical spine manipulative therapy

This abstract is reproduced with the permission of the publisher; full text by subscription. Link to PDF version


 

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