Turner Ryan C, Lucke-Wold Brandon P, Boo Sohyun, Rosen Charles L, Sedney Cara L
Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia.
Center for Neuroscience, West Virginia University School of Medicine, Morgantown, West Virginia.
Biomed Res Rev. 2018;2(1). doi: 10.15761/BRR.1000110. Epub 2018 Mar 25.
Chiropractic cervical manipulation is a common practice utilized around the world. Most patients are never cleared medically for manipulation, which can be devastating for those few who are at increased risk for dissections. The high velocity thrust used in cervical manipulation can produce significant strain on carotid and vertebral vessels. Once a dissection has occurred, the risk of thrombus formation, ischemic stroke, paralysis, and even death is drastically increased. In this case report, we highlight a case of a 32-year-old woman who underwent chiropractic manipulation and had vertebral artery dissection with subsequent brainstem infarct. She quickly deteriorated and passed away shortly after arrival to the hospital. Although rare, one in 48 chiropractors have experienced such an event. We utilize this case to highlight the risk associated with cervical manipulation and urge open dialogue between chiropractors and physicians. Receiving medical clearance prior to cervical manipulation in potential at risk patients would drastically reduce morbidity and mortality.
整脊颈椎手法在世界各地都是一种常见的治疗方法。大多数患者在接受手法治疗前从未进行过医学检查，而这对于少数有血管夹层风险增加的患者来说可能是灾难性的。颈椎手法中使用的高速推力会对颈动脉和椎动脉产生显著的压力。一旦发生血管夹层，血栓形成、缺血性中风、瘫痪甚至死亡的风险会急剧增加。在本病例报告中，我们重点介绍了一名32岁女性，她接受了整脊手法治疗，发生了椎动脉夹层，随后出现脑干梗死。她病情迅速恶化，入院后不久便去世。虽然这种情况很少见，但每48名整脊师中就有一人经历过这样的事件。我们利用这个病例来强调与颈椎手法相关的风险，并敦促整脊师和医生之间进行开放的对话。在有潜在风险的患者进行颈椎手法治疗前获得医学检查许可将大大降低发病率和死亡率。
