Chiropractors across Canada are claiming endorsement from the CMAJ that the risk of a stroke from neck manipulation is one in 5 850 000.1 In the Dec. 2001 edition of the Canadian Chiropractor, Paul Carey claims, “the key difference is that it was published in a major peer-reviewed journal.”2
For the denominator, the authors used all types of neck manipulations done by chiropractors. No distinction was made between those done at the atlas and the axis and those done lower in the neck. Nor was there any distinction made between the velocity, amplitude and degree of rotation of the manipulation. This is equivalent to trying to find out the side effects of thalidomide by counting all pills of any kind prescribed to all people.
For the chiropractors, the numerator was “did the patient sue?” Thus a patient lying in a hospital bed, with a proven prospective dissection on angiogram following a chiropractic neck manipulation, is excluded if they did not take legal action.
Murray S. Katz Tiny Tots Medical Centre Dollard-des-Ormeaux, Que.
References
- 1.Haldeman S, Carey P, Townsend M, Papadopoulos C. Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 2001;165(7):905-6. [PMC free article] [PubMed]
- 2.Rolph M. Can Chiropractor 2001;6(6):11-7.