To estimate the rate of stroke following cervical manipulation by chiropractors, Paul Carey and colleagues examined data from malpractice claims for stroke filed with the Canadian Chiropractic Protective Association from 1988 to 1997 and surveyed 10% of Canadian chiropractors to estimate the number of annual cervical manipulations. The authors found an estimated rate of 1 arterial dissection per 5.85 million cervical manipulations. The authors report this figure is "significantly less than" previous estimates of between 1 in 500 000 and 1 in 1-million manipulations.
In a related commentary, Moira Kapral and Susan Bondy state that while the risk of stroke following cervical manipulations appears to be low, the use of malpractice claims data may not lead to an accurate estimation of the risk because not all stroke events will lead to claims. Drs. Bondy and Kapral suggest practitioners should have realistic and informed discussions with their patients about the potential risks and benefits of this treatment.
Contact: Dr. Paul Carey, President, Canadian Chiropractic Protective Association, Stratford; tel 519-273-0500, email: pfcarey@golden.net
Dr. Moira Kapral, Institute for Clinical Evaluative Sciences, Toronto; tel. 416-340-4642, email: susan.bondy@ices.on.ca
Canadian Medical Association Journal