SAN ANTONIO (Reuters Health) - Study results presented here Friday night are prompting some Canadian neurologists to campaign against neck manipulation by chiropractors.

Tears in the inside wall of a neck artery, known as dissections, appear to be the leading cause of stroke among younger people, note Dr. John W. Norris of the University of Toronto and colleagues. To investigate the link between these tears and stroke, the researchers analyzed 156 cases of cervical artery dissection, and presented their findings here at the American Stroke Association's 27th International Stroke Conference.

When arterial dissection occurs, blood can pool within the wall of the artery, leading to clot formation. The flap made by the tear can also block blood flow. Such clots and blockages can lead to ischemic stroke, in which a portion of the brain is starved for blood and oxygen and brain cells begin to die.

The cervical arteries, which include the carotid arteries running up the side of the neck and the vertebral artery, which follows the course of the spine, are vulnerable to dissection from trauma, the vertebral artery particularly so, Norris and colleagues note.

Trauma was the cause of cervical artery dissection in 98, or 63%, of the 156 cases they analyzed. In 38 cases of trauma, or 39%, the injurious event appeared to be chiropractic neck manipulation. Other traumatic events included turning the head while reversing the car, golfing and painting the ceiling.

Sixteen percent of the patients were found to have malformations in their cervical arteries, which may have made them more vulnerable to dissection.

There is increasing evidence that neck artery dissection is the most common cause of ischemic stroke in people younger than 45, the Canadian team notes. The cause can be spontaneous, but trauma as a cause is often overlooked, the investigators noted in their presentation.

Of the 38 chiropractic patients experiencing stroke, vertebral artery dissection occurred in 30 and carotid artery dissection occurred in 8. Two deaths occurred in the patients who experienced artery damage after neck manipulation.

Based on statistical data, Norris and colleagues estimate that 150 Canadian patients younger than 45 suffer strokes each year as a result of chiropractic neck manipulation.

"There is serious underreporting" of strokes associated with neck manipulation, the researchers state. They speculate that this may have something to do with fear of litigation.

The University of Toronto investigators and other neurologists are planning to launch a movement to ban the practice of neck manipulation.

The American Chiropractic Association had not responded to requests for comment by press time.

Reference Source 89

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