Likelihood of vertebrobasilar stroke following chiropractic spinal manipulation in US adults aged 65-99 with neck pain

Background People with vertebral artery dissection may complain of neck pain. Chiropractors treat neck pain with cervical spine manipulation, which is suspected of aggravating undetected vertebral artery dissection, causing vertebrobasilar stroke (VBS). Case-control studies have temporally - but not causally - linked cervical spine manipulation to VBS in adults aged <45 years, but among older adults the likelihood of VBS following cervical spine manipulation is unknown. Methods We employed a cohort design to analyze Medicare data for 2008. In beneficiaries aged 65-99 with neck pain, we compared the incidence ratio of stroke within thirty days of office visit for either primary care evaluation or chiropractic cervical spine manipulation. We also developed a logistic regression model for likelihood of stroke. The subjects totaled 1,120,293. . Results The specific incidence of VBS was too small to report and thus precluded further analysis. Specific quantities obtained under Medicare-approved research may not be disclosed if the unit of observation contains fewer than eleven subjects. Overall incidence of VBS within 30 days of office visit was less than 10 per million subjects. The likelihood of any stroke occurring within thirty days of office visit for neck pain was significantly lower following cervical spine manipulation than following primary care evaluation.

Conclusions Among Medicare beneficiaries aged 65-99 with neck pain, the incidence of VBS within 30 days of chiropractic spinal manipulation was very low. Chiropractic cervical spine manipulation is unlikely to cause VBS in patients aged 65-99 with neck pain.