What Are the Risks of Cervical Spine (Neck) Chiropractic Manipulations

When looking at the potential risks of neck manipulation, the risk benefit analysis should include the following considerations: Risks of adjustments compared with other neck treatments versus benefits from the adjustments compared with other neck treatments.

The Risks Involved

Studies looking at incidence of stroke from neck manipulations show a risk to be 1 to 3 adverse events per million adjustments. Studies by Dvorak, Jaskoviak, and from Canada found significant variations in cerebrovascular incident complications. One study found no complications in 5 million neck manipulations, another a rate of one serious complication per 400,000 cervical manipulations, and the other found 55 CVA's out of 50 million adjustments.

How often do people die from neck adjustments? Terrett et al found a mortality rate of 23% among the incidences reported in the literature. A conservative estimate death from stroke caused by a neck adjustment is therefore around one in 4 million.

What's the Risk of a Neck Adjustment Compared to being Treated with Non-Steroidal Anti-Inflammatories?

The risk of non-steroidal anti-inflammatories show about 3200 deaths attributed each year in the US. This is a rate of 4/10,000 patients being treated and sustaining ulcers leading to a fatal complication.

The Effectiveness of Chiropractic Cervical Adjustments?

Evidence from multiple sources has shown that neck adjustments provide at least short term pain relief for patients with subacute or chronic neck pain. There also is some evidence in the literature supporting cervical spine manipulation for nonmigraine headaches.

A study by Koes et al compared manipulation treatment to traditional treatments (with NSAIDS). Chiropractic treatment turned out to be superior with the results persisting even at the 12 month follow up.

Summary:

Risk of stroke from cervical manipulation = somewhere around 1 in a million based on the existing research.

One-third resolve with mild or no issues.

One-fourth of these strokes are fatal, so overall about 40-50 manipulation caused strokes in the US per year, and about a dozen deaths.

Perspective:

One is almost 100 times more likely to die from an NSAID related issue.

Statistically you have a greater risk of being killed or seriously injured in a car accident on the way to a doctor's office visit than having a serious complication from your chiropractic neck treatment.

In other words, the risks are very small but very real. Chiropractic treatment is very safe, however, risks exist just as they do every time one gets behind the wheel of an automobile.

David L. Greene, MD is CEO of Preferred Pain Center in Phoenix, Arizona which serves the Phoenix and Scottsdale Az metropolitan and surrounding areas. He can be reached at dgreene@preferredpaincenter.com and (602) 507-6550.

Preferred Pain Center is a Comprehensive Pain Center including Medical and Interventional Pain Management, Chiropractic, Physical Therapy, Spinal Decompression Therapy, Naturopathic Medicine, and Manipulation Under Anesthesia. The website is http://www.preferredpaincenter.com and the Blog of Pain is http://blog.preferredpaincenter.com