Health Services Research, Southern California University of Health Sciences, Whittier, CA, USA.
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA.
Eur Spine J. 2023 Oct;32(10):3497-3504. doi: 10.1007/s00586-023-07844-9. Epub 2023 Jul 8.
Cervical artery dissection (CeAD), which includes both vertebral artery dissection (VAD) and carotid artery dissection (CAD), is the most serious safety concern associated with cervical spinal manipulation (CSM). We evaluated the association between CSM and CeAD among US adults.
Through analysis of health claims data, we employed a case-control study with matched controls, a case-control design in which controls were diagnosed with ischemic stroke, and a case-crossover design in which recent exposures were compared to exposures in the same case that occurred 6-7 months earlier. We evaluated the association between CeAD and the 3-level exposure, CSM versus office visit for medical evaluation and management (E&M) versus neither, with E&M set as the referent group.
We identified 2337 VAD cases and 2916 CAD cases. Compared to population controls, VAD cases were 0.17 (95% CI 0.09 to 0.32) times as likely to have received CSM in the previous week as compared to E&M. In other words, E&M was about 5 times more likely than CSM in the previous week in cases, relative to controls. CSM was 2.53 (95% CI 1.71 to 3.68) times as likely as E&M in the previous week among individuals with VAD than among individuals experiencing a stroke without CeAD. In the case-crossover study, CSM was 0.38 (95% CI 0.15 to 0.91) times as likely as E&M in the week before a VAD, relative to 6 months earlier. In other words, E&M was approximately 3 times more likely than CSM in the previous week in cases, relative to controls. Results for the 14-day and 30-day timeframes were similar to those at one week.
Among privately insured US adults, the overall risk of CeAD is very low. Prior receipt of CSM was more likely than E&M among VAD patients as compared to stroke patients. However, for CAD patients as compared to stroke patients, as well as for both VAD and CAD patients in comparison with population controls and in case-crossover analysis, prior receipt of E&M was more likely than CSM.
颈椎动脉夹层（CeAD）包括椎动脉夹层（VAD）和颈动脉夹层（CAD），是与颈椎推拿（CSM）相关的最严重的安全隐患。我们评估了美国成年人中 CSM 和 CeAD 之间的关联。
通过健康索赔数据分析，我们采用病例对照研究，对照为缺血性脑卒中患者，病例交叉设计，最近的暴露与 6-7 个月前的同一病例的暴露进行比较。我们评估了 CeAD 与 3 级暴露（CSM 与医疗评估和管理（E&M）就诊和既无暴露）之间的关联，以 E&M 作为参照组。
我们确定了 2337 例 VAD 病例和 2916 例 CAD 病例。与人群对照相比，VAD 病例在过去一周内接受 CSM 的可能性是接受 E&M 的 0.17（95%CI 0.09 至 0.32）倍。换句话说，在病例中，E&M 比 CSM 更有可能在过去一周内发生，相对于对照组。在 VAD 患者中，CSM 在过去一周内发生的可能性是 E&M 的 2.53（95%CI 1.71 至 3.68）倍，而在没有 CeAD 的脑卒中患者中。在病例交叉研究中，CSM 在 VAD 前一周发生的可能性是 E&M 的 0.38（95%CI 0.15 至 0.91）倍，而在 6 个月前。换句话说，在病例中，E&M 比 CSM 更有可能在过去一周内发生，相对于对照组。14 天和 30 天的时间框架的结果与一周时相似。
在私人保险的美国成年人中，CeAD 的总体风险非常低。与脑卒中患者相比，VAD 患者接受 CSM 的可能性大于 E&M。然而，与脑卒中患者相比，CAD 患者以及 VAD 和 CAD 患者与人群对照和病例交叉分析相比，E&M 发生的可能性大于 CSM。
