The risk of stroke with chiropractic

The association between stroke/cerebrovascular accident and manipulative procedures performed to the cervical spine is an issue that gets lots of attention from the media and critics of chiropractic.

Supporters of chiropractic counter that the critics take the “very remote” risk of vertebral artery dissection (VAD), which results in a stroke, and disproportionately magnify the “fear factor” in the general population.

They estimate that more than 300 million cervical adjustments are performed each year in the United States, and the risk of a VAD is probably not more than 1.0 to 1.5 per 100,000 people. That works out to a conservative estimate of 1000 cases of VAD annually.

A recent review in eMedicine agrees with this estimate of VAD risk.

How do we reconcile this with the fact that Bayer Corporation withdrew the drug Baycol (cerivastatin) from the U.S. market after a total of 31 deaths were associated with the use of this lipid-lowering drug? Using the estimate of 300 million cervical adjustments each year, we might expect 1,000 cases of VAD annually. If just 3% of these patients die (as was reported in one survey), that would come to 30 deaths each year!

For people receiving chiropractic manipulation, it’s probably reasonable to ask the practitioner to avoid manipulation of the neck if possible.

7/19/06 20:25 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.