Guest guest Posted July 12, 2011 Report Share Posted July 12, 2011  Dr. s, Thank you for bring up one of the great myths of chiropractic id est that a cavitation accompanying a thrust constitutes a successful adjustment. I have been adjusting in my present technique since 1980 and have yet to produce a cavitation however if you are ever in my office I will show you a collection of before and after X-rays as good as any you've seen. Herb Chiropractic deaths Docs:I especially like their "Conclusion."Lyndon McGill, D.C.Salem, Oregonwww.SalemSpineClinic.comwww.EvolvingDaily.com <Wiley_pub2-logo-2lines.gif> Deaths after Chiropractic: A Review of Published Cases E. Ernst Posted: 08/30/2010; Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing Abstract and Introduction Abstract Objective: The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death.Design: This study is a systematic review of case reports.Methods: Literature searches in four electronic databases with no restrictions of time or language.Main outcome measure: Death.Results: Twenty six fatalities were published in the medical literature and many more might have remained unpublished. The alleged pathology usually was a vascular accident involving the dissection of a vertebral artery.Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit. Introduction Vascular accidents after upper spinal manipulation are a well-recognised problem (e.g.[1,2]). Dissection of a vertebral artery, caused by extension and rotation of the neck beyond the physiological range of motion, is thought to be the underlying mechanism.[2] Several deaths have been reported as a consequence. Some proponents of chiropractic seem to believe that the critical evaluation of this evidence amounts to a 'scare story' (Chairman of the UK General Chiropractic Council)[3] or to 'puffing up (the evidence) out of all proportion' (President of the British Chiropractic Association).[4] A responsible approach to serious therapeutic risks, however, requires an open discussion of the facts. In this review, I aimed to provide the basis for such a discussion by summarising all fatalities which occurred after chiropractic spinal manipulation and were published in the medical literature. Methods Electronic searches were conducted in the following electronic databases: Medline, Embase, AMED, Cochrane Library (September 2009). No restrictions of time or language were applied. Search terms were chiropractic, spinal manipulation, vascular accidents, stroke, death and fatality. In addition, our own departmental files and the bibliographies of the articles thus located were searched. Several experts were also contacted for further data. Case reports were included if they provided information on human patients who had died after receiving one or more treatments from a chiropractor. Data were extracted from the included articles according to predefined criteria (Table 1). Table 1. Published case reports of deaths after chiropractic treatments References Year of publication Victim Type of vascular accident Time between treatment and death Anon[5] 1934 Woman, age unknown Tear in left lateral sinus 2 weeks Pratt- and Berger[6] 1947 32-year-old man Thrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries 24 h Pratt- and Berger[6] 1947 35-year-old woman Thrombosis of posterior-inferior cerebellar artery 10 h Anon[7] 1955 Woman, age unknown Intra-spinal bleeding and compression of spinal cord 18 h Ford and [8] 1956 37-year-old man Thrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries 6 h Ford and [8] 1956 No information provided Thrombosis of basilar artery No information provided and Estridge[9] 1962 33-year-old woman Infarct of cerebellar and brainstem 3 days Lorenz and Vogelsang[10] 1972 39-year-old woman Thrombosis of basilar artery 58 days Schmitt[11] 1976 35-years-old woman Infarct of brainstem 1 h Krueger and Okazaki[12] 1980 25-year-old man Infarct of brainstem and cerebellum 48 h Sherman et al.[13] 1981 60-year-old woman Dissection of vertebral artery 4 days Ali Cherif et al.[14] 1983 51-year-old man Infarct of medulla oblongata 11 days Nielsen[15] 1984 34-year-old man Dissection of vertebral artery aneurysen 3 h Zak and Carmody[16] 1984 53-year-old man Left vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction 27 days Modde[17] 1985 26-year-old woman Dissection of vertebral artery 1 day Jentzen et al.[18] 1987 51-year-old man Infarct of cerebellum and brainstem No information provided Sherman et al.[20] 1987 37-year-old man Infarct of brainstem 3 days Mas et al.[19] 1989 35-year-old woman Dissecting aneurysm of vertebral artery 16 h Raskind and North[21] 1990 47-year-old woman Cerebellar haemorrheae No information provided Sullivan[22] 1992 41-year-old woman Haemorrhage in ventricular system 8 h Haynes[23] 1994 36-year-old woman Dissecting aneurysm of vertebral artery, thrombo-embolism No information provided s et al.[24] 1995 29-year-old woman Infarct of right hemisphere 3 days Klougart et al.[25] 1996 34-year-old man Unclear Few hours Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Dziewas et al.[27] 2003 No information provided No information provided No information provided Results Twenty-six fatalities were published since 1934 in 23 articles (Table 1).[5–27] Table 1. Published case reports of deaths after chiropractic treatments References Year of publication Victim Type of vascular accident Time between treatment and death Anon[5] 1934 Woman, age unknown Tear in left lateral sinus 2 weeks Pratt- and Berger[6] 1947 32-year-old man Thrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries 24 h Pratt- and Berger[6] 1947 35-year-old woman Thrombosis of posterior-inferior cerebellar artery 10 h Anon[7] 1955 Woman, age unknown Intra-spinal bleeding and compression of spinal cord 18 h Ford and [8] 1956 37-year-old man Thrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries 6 h Ford and [8] 1956 No information provided Thrombosis of basilar artery No information provided and Estridge[9] 1962 33-year-old woman Infarct of cerebellar and brainstem 3 days Lorenz and Vogelsang[10] 1972 39-year-old woman Thrombosis of basilar artery 58 days Schmitt[11] 1976 35-years-old woman Infarct of brainstem 1 h Krueger and Okazaki[12] 1980 25-year-old man Infarct of brainstem and cerebellum 48 h Sherman et al.[13] 1981 60-year-old woman Dissection of vertebral artery 4 days Ali Cherif et al.[14] 1983 51-year-old man Infarct of medulla oblongata 11 days Nielsen[15] 1984 34-year-old man Dissection of vertebral artery aneurysen 3 h Zak and Carmody[16] 1984 53-year-old man Left vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction 27 days Modde[17] 1985 26-year-old woman Dissection of vertebral artery 1 day Jentzen et al.[18] 1987 51-year-old man Infarct of cerebellum and brainstem No information provided Sherman et al.[20] 1987 37-year-old man Infarct of brainstem 3 days Mas et al.[19] 1989 35-year-old woman Dissecting aneurysm of vertebral artery 16 h Raskind and North[21] 1990 47-year-old woman Cerebellar haemorrheae No information provided Sullivan[22] 1992 41-year-old woman Haemorrhage in ventricular system 8 h Haynes[23] 1994 36-year-old woman Dissecting aneurysm of vertebral artery, thrombo-embolism No information provided s et al.[24] 1995 29-year-old woman Infarct of right hemisphere 3 days Klougart et al.[25] 1996 34-year-old man Unclear Few hours Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Dziewas et al.[27] 2003 No information provided No information provided No information provided Most of the victims were relatively young; 14 were below the age of 40. There was a slight majority of female patients. The type of complication associated with death frequently related to a vascular accident leading to thrombosis and cerebral infarction. The time between treatment and death ranged from 1 h to 58 days; in 10 cases, it was 1 day or less. Unfortunately, the published information was often incomplete. Many other fatalities seem to have remained unpublished. For instance, the testimony of the chiropractor Preston Long for a court in Connecticut recently listed the family names of nine victims: Mathiason, Solsbury, Mc Cornick, Venegas, Bedenbaugh, , Fawcett, Parisien, Standt. Long also states that 'many others [are] unknown hidden behind legal agreements of silence'.[28] A website names further North American fatalities: Epping (California), G. Fowden (Utah), Grainger (Alberta), Hoffman (land), Renate Dora Labonte (Ontario), (California), Pereyra (Connecticut), A. Roth (Ontario) and Lee Strohecker (Pennsylvania).[29] Discussion This systematic review demonstrates that numerous deaths have been associated with chiropractic. Usually high-velocity, short-lever thrusts of the upper spine with rotation are implicated. They are believed to cause vertebral arterial dissection in predisposed individuals which, in turn, can lead to a chain of events including stroke and death.[1,2,26,30] Many chiropractors claim that, because arterial dissection can also occur spontaneously, causality between the chiropractic intervention and arterial dissection is not proven. However, when carefully evaluating the known facts, one does arrive at the conclusion that causality is at least likely (e.g.[30,31]). Even if it were merely a remote possibility, the precautionary principle in healthcare would mean that neck manipulations should be considered unsafe until proven otherwise. Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition.[32] Thus, the risk-benefit balance for chiropractic neck manipulation fails to be positive. Reliable estimates of the frequency of vascular accidents are prevented by the fact that under-reporting is known to be substantial. In a survey of UK neurologists, for instance, under-reporting of serious complications was 100%.[33] Those cases which are published often turn out to be incomplete. Of 40 case reports of serious adverse effects associated with spinal manipulation, nine failed to provide any information about the clinical outcome.[34] Incomplete reporting of outcomes might therefore further increase the true number of fatalities. Obviously, the present article is not aimed at providing incidence figures; this would require a different methodology entirely. To date, no reliable incidence data are available. This review is focussed on deaths after chiropractic, yet neck manipulations are, of course, used by other healthcare professionals as well. The reason for this focus is simple: chiropractors are more frequently associated with serious manipulation-related adverse effects than osteopaths, physiotherapists, doctors or other professionals. Of the 40 cases of serious adverse effects mentioned above, 28 can be traced back to a chiropractor and none to an osteopath.[34] A review of complications after spinal manipulations by any type of healthcare professional included three deaths related to osteopaths, nine to medical practitioners, none to a physiotherapist, one to a naturopath and 17 to chiropractors.[35] This article also summarised a total of 265 vascular accidents of which 142 were linked to chiropractors. Another review of complications after neck manipulations published by 1997 included 177 vascular accidents, 32 of which were fatal. The vast majority of these cases were associated with chiropractic and none with physiotherapy.[36] The most obvious explanation for the dominance of chiropractic is that chiropractors routinely employ high-velocity, short-lever thrusts on the upper spine with a rotational element, while the other healthcare professionals use them much more sparingly.[37,38] In conclusion, numerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly. Sidebar What's Known Chiropractic upper spinal manipulation has repeatedly been associated with arterial dissection followed by stroke and, in some cases, death. What's New The article is the first systematic review of all fatalities reported in the medical literature. Twenty-six deaths are on record and many more seem to have remained unpublished. References Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100: 330–8. Leon- A, Cuetter A, Ferrer G. Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J 2007; 100: 201–3. Dixon P. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. BJ. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. Anon. Medicolegal. Malpractice: death resulting from chiropractic treatment for headache. J Am Med Assoc 1934; 103:1260, 1935; 105:1712–4, 1937; 109:233–4. Pratt- HR, Berger KE. Cerebellar and spinal injuries after chiropractic manipulation. J Am Med Assoc 1947; 133: 600–3. Anon. Medicolegal abstracts. Chiropractors: injury to spinal meninges during adjustments. J Am Med Assoc 1955; 159: 809. Ford FR, D. Thrombosis of the basilar artery with softenings in the cerebellum and brain stem due to manipulation of the neck; a report of two cases with one post-mortem examination, reasons are given to prove that damage to the vertebral arteries is responsible. Bull s Hopkins Hosp 1956; 98: 37–42. RA, Estridge MN. Neurologic complications of head and neck manipulations. JAMA 1962; 182: 528–31. Lorenz R, Vogelsang HG. Thrombosis of the basilar artery following chiropractic manipulation of the cervical spine. [in German] Thrombose der arteria basilaris nach chiropraktischen Manipulationen an der Halbwirbelsäule. Dtsch Med Wochenschr 1972; 97: 36–43. Schmitt HP. Rupturen und Thrombosen der Arteria vertebralis nach gedeckten mechanischen Insulten. Schweiz Arch Neurol Neurochir Psychiatry 1976; 119: 363–79. Krueger BR, Okazaki H. Vertebral-basilar distribution infarction following chiropractic cervical manipulation. Mayo Clin Proc 1980; 55: 322–32. Sherman DG, Hart RG, Easton JD. Abrupt change in head position and cerebral infarction. Stroke 1981; 12: 2–6. Ali Cherif A, Delpuech F, Habib M, Salamon G, Khalil R. Thrombose vertebro-basilaire apres manipulation du rachis cervical. A propos de deux cas. Ann de Med Phys 1983; 25: 459–65. Nielsen AA. Cerebrovascular insults caused by manipulation of the cervical spine. [in Danish]. Ugeskr Laeger 1984; 146: 3267–70. Zak SM, Carmody RF. Cerebellar infarction from chiropractic neck manipulation: case report and review of the literature. Ariz Med 1984; 41: 333–7. Modde PJ. Chiropractic Malpractice. Columbia, land: Hanrow Press. 1985: 269–70, 273–5, 311–8, 322–3, 329–31, 334–7. Jentzen JM, Amatuzio J, GF. Complications of cervical manipulation: a case report of fatal brainstem infarct with review of the mechanisms and predisposing factors. J Forensic Sci 1987; 32: 1089–94. Mas JL, Henin D, Bousser MG, Chain F, Haw JJ. Dissecting aneurysm of the vertebral artery and cervical manipulation: a case report with autopsy. Neurology 1989; 39: 512–5. Sherman MR, Smialek JE, Zane WE. Pathogenesis of vertebral artery occlusion following cervical spine manipulation. Arch Pathol Lab Med 1987; 111: 851–3. Raskind R, North CM. Vertebral artery injuries following chiropractic cervical spine manipulation--case reports. Angiology 1990; 41: 445–52. Sullivan EC. Brain stem stroke syndromes from cervical adjustments. Report on five cases. J Chiropr Res Clin Invest 1992; 8: 12–6. Haynes MJ. Stroke following cervical manipulation in Perth. Chiropr J Aust 1994; 24: 42–6. s M, Bohl J, Thömke F, Kallen K-J, Mahlzahn K, Wandel E. Dissection of the internal carotid artery after chiropractic manipulation of the neck. Neurology 1995; 45: 2284–6. Klougart N, Leboeuf-Yde C, Rasmussen LR. Safety in chiropractic practice. Part I. The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978–1988. J Manipulative Physiol Ther 1996; 19: 371–7. Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation. Spine 2002; 27: 49–55. Dziewas R, Konrad C, Dräger B et al. Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 2003; 250: 1179–84. Presentation by Dr Preston Long DC to State of Connecticut. Connecticut State Board of Chiropractic Examiners. Hartford Connecticut. 25 October 2009. Anon. What's the harm in going to a chiropractor? What's the Harm 2009; http://whatstheharm.net/chiropractic.html (accessed October 2009). Ernst E. Vascular accidents after neck manipulation: cause or coincidence? Int J Clin Pract 2009; in press. Long PH. Stroke and spinal manipulation. J Quality Health Care 2004; 3: 8–10. Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage 2008; 35: 544–62. Stevinson C, Honan W, Cooke B, Ernst E. Neurological complications of cervical spine manipulation. J Roy Soc Med 2001; 94: 107–10. Ernst E. Cerebrovascular complications associated with spinal manipulation. Phys Ther Rev 2004; 9: 5–15. Terrett AGJ. Current Concepts in Vertebrobasilar Complications following Spinal Manipulation, 2nd edn. Des Moines: JCMIC Group, 2001. Di Fabio RP. Manipulation of the cervical spine: risks and benefits. Physical Ther 1999; 79: 50–65. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore (NY) 2009; 5: 290–5. Sweeney A, Doody C Manual therapy for the cervical spine and reported adverse effects: a survey of Irish Manipulative Physiotherapists. Man Ther 2010; 15: 32–6. Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2011 Report Share Posted July 12, 2011 As a lay person, (and a guy who enjoys traditional "cavitation" adjustments), I have nevertheless been in Dr. Herb Freeman's office (a time or two). Never been (cavitated) while there, but I will say I walked out feeling awefully taller, straighter, looser, and like I just had a complete full body massage. I've also literally crawled into his office with acute lower back spasms, and walked out. I once got carried into his son's house on an emergency basis one Sunday afternoon many years ago (by a guy who was moved to go to Palmer West after he then watched me then walk out of the house on my own a few instrument "squirts" later). I still love a good side posture (and even am convinced I need them a few times a year), and I also like traditional cervical adjustments. But the most awesome, mobile, and loose I ever felt after a chiropractic manipulation was when I once walked out of the Eugene clinic of the late DeSiena, D.C., who was pure activator protocol. Those adjustments felt so good while they were happening, I was actually kind of sad when the table rotated back up and it was time for me to leave. G. Gatti, Gatti, Maier, Sayer, Thayer, & Associates1781 Liberty St. SESalem, OR 973021-(800) 289-3443 msmith@... From: [mailto: ] On Behalf Of BERNICE FREEMANSent: Tuesday, July 12, 2011 2:12 PM M. s, D.C.; Subject: Re: Chiropractic deaths  Dr. s, Thank you for bring up one of the great myths of chiropractic id est that a cavitation accompanying a thrust constitutes a successful adjustment. I have been adjusting in my present technique since 1980 and have yet to produce a cavitation however if you are ever in my office I will show you a collection of before and after X-rays as good as any you've seen. Herb Chiropractic deathsDocs:I especially like their "Conclusion."Lyndon McGill, D.C.Salem, Oregonwww.SalemSpineClinic.comwww.EvolvingDaily.com <Wiley_pub2-logo-2lines.gif> Deaths after Chiropractic: A Review of Published CasesE. ErnstPosted: 08/30/2010; Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell PublishingAbstract and IntroductionAbstractObjective: The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death.Design: This study is a systematic review of case reports.Methods: Literature searches in four electronic databases with no restrictions of time or language.Main outcome measure: Death.Results: Twenty six fatalities were published in the medical literature and many more might have remained unpublished. The alleged pathology usually was a vascular accident involving the dissection of a vertebral artery.Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.IntroductionVascular accidents after upper spinal manipulation are a well-recognised problem (e.g.[1,2]). Dissection of a vertebral artery, caused by extension and rotation of the neck beyond the physiological range of motion, is thought to be the underlying mechanism.[2] Several deaths have been reported as a consequence. Some proponents of chiropractic seem to believe that the critical evaluation of this evidence amounts to a 'scare story' (Chairman of the UK General Chiropractic Council)[3] or to 'puffing up (the evidence) out of all proportion' (President of the British Chiropractic Association).[4] A responsible approach to serious therapeutic risks, however, requires an open discussion of the facts.In this review, I aimed to provide the basis for such a discussion by summarising all fatalities which occurred after chiropractic spinal manipulation and were published in the medical literature.MethodsElectronic searches were conducted in the following electronic databases: Medline, Embase, AMED, Cochrane Library (September 2009). No restrictions of time or language were applied. Search terms were chiropractic, spinal manipulation, vascular accidents, stroke, death and fatality. In addition, our own departmental files and the bibliographies of the articles thus located were searched. Several experts were also contacted for further data. Case reports were included if they provided information on human patients who had died after receiving one or more treatments from a chiropractor. Data were extracted from the included articles according to predefined criteria (Table 1).Table 1. Published case reports of deaths after chiropractic treatmentsReferencesYear of publicationVictimType of vascular accidentTime between treatment and deathAnon[5] 1934Woman, age unknownTear in left lateral sinus2 weeksPratt- and Berger[6] 194732-year-old manThrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries24 hPratt- and Berger[6] 194735-year-old womanThrombosis of posterior-inferior cerebellar artery10 hAnon[7] 1955Woman, age unknownIntra-spinal bleeding and compression of spinal cord18 hFord and [8] 195637-year-old manThrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries6 hFord and [8] 1956No information providedThrombosis of basilar arteryNo information provided and Estridge[9] 196233-year-old womanInfarct of cerebellar and brainstem3 daysLorenz and Vogelsang[10] 197239-year-old womanThrombosis of basilar artery58 daysSchmitt[11] 197635-years-old womanInfarct of brainstem1 hKrueger and Okazaki[12] 198025-year-old manInfarct of brainstem and cerebellum48 hSherman et al.[13] 198160-year-old womanDissection of vertebral artery4 daysAli Cherif et al.[14] 198351-year-old manInfarct of medulla oblongata11 daysNielsen[15] 198434-year-old manDissection of vertebral artery aneurysen3 hZak and Carmody[16] 198453-year-old manLeft vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction27 daysModde[17] 198526-year-old womanDissection of vertebral artery1 dayJentzen et al.[18] 198751-year-old manInfarct of cerebellum and brainstemNo information providedSherman et al.[20] 198737-year-old manInfarct of brainstem3 daysMas et al.[19] 198935-year-old womanDissecting aneurysm of vertebral artery16 hRaskind and North[21] 199047-year-old womanCerebellar haemorrheaeNo information providedSullivan[22] 199241-year-old womanHaemorrhage in ventricular system8 hHaynes[23] 199436-year-old womanDissecting aneurysm of vertebral artery, thrombo-embolismNo information provideds et al.[24] 199529-year-old womanInfarct of right hemisphere3 daysKlougart et al.[25] 199634-year-old manUnclearFew hoursHaldeman et al.[26] 2002Previously unpublished legal casesNo information providedNo information providedHaldeman et al.[26] 2002Previously unpublished legal casesNo information providedNo information providedDziewas et al.[27] 2003No information providedNo information providedNo information providedResultsTwenty-six fatalities were published since 1934 in 23 articles (Table 1).[5–27] Table 1. Published case reports of deaths after chiropractic treatmentsReferencesYear of publicationVictimType of vascular accidentTime between treatment and deathAnon[5] 1934Woman, age unknownTear in left lateral sinus2 weeksPratt- and Berger[6] 194732-year-old manThrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries24 hPratt- and Berger[6] 194735-year-old womanThrombosis of posterior-inferior cerebellar artery10 hAnon[7] 1955Woman, age unknownIntra-spinal bleeding and compression of spinal cord18 hFord and [8] 195637-year-old manThrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries6 hFord and [8] 1956No information providedThrombosis of basilar arteryNo information provided and Estridge[9] 196233-year-old womanInfarct of cerebellar and brainstem3 daysLorenz and Vogelsang[10] 197239-year-old womanThrombosis of basilar artery58 daysSchmitt[11] 197635-years-old womanInfarct of brainstem1 hKrueger and Okazaki[12] 198025-year-old manInfarct of brainstem and cerebellum48 hSherman et al.[13] 198160-year-old womanDissection of vertebral artery4 daysAli Cherif et al.[14] 198351-year-old manInfarct of medulla oblongata11 daysNielsen[15] 198434-year-old manDissection of vertebral artery aneurysen3 hZak and Carmody[16] 198453-year-old manLeft vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction27 daysModde[17] 198526-year-old womanDissection of vertebral artery1 dayJentzen et al.[18] 198751-year-old manInfarct of cerebellum and brainstemNo information providedSherman et al.[20] 198737-year-old manInfarct of brainstem3 daysMas et al.[19] 198935-year-old womanDissecting aneurysm of vertebral artery16 hRaskind and North[21] 199047-year-old womanCerebellar haemorrheaeNo information providedSullivan[22] 199241-year-old womanHaemorrhage in ventricular system8 hHaynes[23] 199436-year-old womanDissecting aneurysm of vertebral artery, thrombo-embolismNo information provideds et al.[24] 199529-year-old womanInfarct of right hemisphere3 daysKlougart et al.[25] 199634-year-old manUnclearFew hoursHaldeman et al.[26] 2002Previously unpublished legal casesNo information providedNo information providedHaldeman et al.[26] 2002Previously unpublished legal casesNo information providedNo information providedDziewas et al.[27] 2003No information providedNo information providedNo information providedMost of the victims were relatively young; 14 were below the age of 40. There was a slight majority of female patients. The type of complication associated with death frequently related to a vascular accident leading to thrombosis and cerebral infarction. The time between treatment and death ranged from 1 h to 58 days; in 10 cases, it was 1 day or less. Unfortunately, the published information was often incomplete.Many other fatalities seem to have remained unpublished. For instance, the testimony of the chiropractor Preston Long for a court in Connecticut recently listed the family names of nine victims: Mathiason, Solsbury, Mc Cornick, Venegas, Bedenbaugh, , Fawcett, Parisien, Standt. Long also states that 'many others [are] unknown hidden behind legal agreements of silence'.[28] A website names further North American fatalities: Epping (California), G. Fowden (Utah), Grainger (Alberta), Hoffman (land), Renate Dora Labonte (Ontario), (California), Pereyra (Connecticut), A. Roth (Ontario) and Lee Strohecker (Pennsylvania).[29] DiscussionThis systematic review demonstrates that numerous deaths have been associated with chiropractic. Usually high-velocity, short-lever thrusts of the upper spine with rotation are implicated. They are believed to cause vertebral arterial dissection in predisposed individuals which, in turn, can lead to a chain of events including stroke and death.[1,2,26,30] Many chiropractors claim that, because arterial dissection can also occur spontaneously, causality between the chiropractic intervention and arterial dissection is not proven. However, when carefully evaluating the known facts, one does arrive at the conclusion that causality is at least likely (e.g.[30,31]). Even if it were merely a remote possibility, the precautionary principle in healthcare would mean that neck manipulations should be considered unsafe until proven otherwise. Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition.[32] Thus, the risk-benefit balance for chiropractic neck manipulation fails to be positive.Reliable estimates of the frequency of vascular accidents are prevented by the fact that under-reporting is known to be substantial. In a survey of UK neurologists, for instance, under-reporting of serious complications was 100%.[33] Those cases which are published often turn out to be incomplete. Of 40 case reports of serious adverse effects associated with spinal manipulation, nine failed to provide any information about the clinical outcome.[34] Incomplete reporting of outcomes might therefore further increase the true number of fatalities. Obviously, the present article is not aimed at providing incidence figures; this would require a different methodology entirely. To date, no reliable incidence data are available.This review is focussed on deaths after chiropractic, yet neck manipulations are, of course, used by other healthcare professionals as well. The reason for this focus is simple: chiropractors are more frequently associated with serious manipulation-related adverse effects than osteopaths, physiotherapists, doctors or other professionals. Of the 40 cases of serious adverse effects mentioned above, 28 can be traced back to a chiropractor and none to an osteopath.[34] A review of complications after spinal manipulations by any type of healthcare professional included three deaths related to osteopaths, nine to medical practitioners, none to a physiotherapist, one to a naturopath and 17 to chiropractors.[35] This article also summarised a total of 265 vascular accidents of which 142 were linked to chiropractors. Another review of complications after neck manipulations published by 1997 included 177 vascular accidents, 32 of which were fatal. The vast majority of these cases were associated with chiropractic and none with physiotherapy.[36] The most obvious explanation for the dominance of chiropractic is that chiropractors routinely employ high-velocity, short-lever thrusts on the upper spine with a rotational element, while the other healthcare professionals use them much more sparingly.[37,38] In conclusion, numerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly.SidebarWhat's KnownChiropractic upper spinal manipulation has repeatedly been associated with arterial dissection followed by stroke and, in some cases, death.What's NewThe article is the first systematic review of all fatalities reported in the medical literature. Twenty-six deaths are on record and many more seem to have remained unpublished.ReferencesErnst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100: 330–8. Leon- A, Cuetter A, Ferrer G. Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J 2007; 100: 201–3. Dixon P. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. BJ. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. Anon. Medicolegal. Malpractice: death resulting from chiropractic treatment for headache. J Am Med Assoc 1934; 103:1260, 1935; 105:1712–4, 1937; 109:233–4. Pratt- HR, Berger KE. Cerebellar and spinal injuries after chiropractic manipulation. J Am Med Assoc 1947; 133: 600–3. Anon. Medicolegal abstracts. Chiropractors: injury to spinal meninges during adjustments. J Am Med Assoc 1955; 159: 809. Ford FR, D. Thrombosis of the basilar artery with softenings in the cerebellum and brain stem due to manipulation of the neck; a report of two cases with one post-mortem examination, reasons are given to prove that damage to the vertebral arteries is responsible. Bull s Hopkins Hosp 1956; 98: 37–42. RA, Estridge MN. Neurologic complications of head and neck manipulations. JAMA 1962; 182: 528–31. Lorenz R, Vogelsang HG. Thrombosis of the basilar artery following chiropractic manipulation of the cervical spine. [in German] Thrombose der arteria basilaris nach chiropraktischen Manipulationen an der Halbwirbelsäule. Dtsch Med Wochenschr 1972; 97: 36–43. Schmitt HP. Rupturen und Thrombosen der Arteria vertebralis nach gedeckten mechanischen Insulten. Schweiz Arch Neurol Neurochir Psychiatry 1976; 119: 363–79. Krueger BR, Okazaki H. Vertebral-basilar distribution infarction following chiropractic cervical manipulation. Mayo Clin Proc 1980; 55: 322–32. Sherman DG, Hart RG, Easton JD. Abrupt change in head position and cerebral infarction. Stroke 1981; 12: 2–6. Ali Cherif A, Delpuech F, Habib M, Salamon G, Khalil R. Thrombose vertebro-basilaire apres manipulation du rachis cervical. A propos de deux cas. Ann de Med Phys 1983; 25: 459–65. Nielsen AA. Cerebrovascular insults caused by manipulation of the cervical spine. [in Danish]. Ugeskr Laeger 1984; 146: 3267–70. Zak SM, Carmody RF. Cerebellar infarction from chiropractic neck manipulation: case report and review of the literature. Ariz Med 1984; 41: 333–7. Modde PJ. Chiropractic Malpractice. Columbia, land: Hanrow Press. 1985: 269–70, 273–5, 311–8, 322–3, 329–31, 334–7. Jentzen JM, Amatuzio J, GF. Complications of cervical manipulation: a case report of fatal brainstem infarct with review of the mechanisms and predisposing factors. J Forensic Sci 1987; 32: 1089–94. Mas JL, Henin D, Bousser MG, Chain F, Haw JJ. Dissecting aneurysm of the vertebral artery and cervical manipulation: a case report with autopsy. Neurology 1989; 39: 512–5. Sherman MR, Smialek JE, Zane WE. Pathogenesis of vertebral artery occlusion following cervical spine manipulation. Arch Pathol Lab Med 1987; 111: 851–3. Raskind R, North CM. Vertebral artery injuries following chiropractic cervical spine manipulation--case reports. Angiology 1990; 41: 445–52. Sullivan EC. Brain stem stroke syndromes from cervical adjustments. Report on five cases. J Chiropr Res Clin Invest 1992; 8: 12–6. Haynes MJ. Stroke following cervical manipulation in Perth. Chiropr J Aust 1994; 24: 42–6. s M, Bohl J, Thömke F, Kallen K-J, Mahlzahn K, Wandel E. Dissection of the internal carotid artery after chiropractic manipulation of the neck. Neurology 1995; 45: 2284–6. Klougart N, Leboeuf-Yde C, Rasmussen LR. Safety in chiropractic practice. Part I. The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978–1988. J Manipulative Physiol Ther 1996; 19: 371–7. Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation. Spine 2002; 27: 49–55. Dziewas R, Konrad C, Dräger B et al. Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 2003; 250: 1179–84. Presentation by Dr Preston Long DC to State of Connecticut. Connecticut State Board of Chiropractic Examiners. Hartford Connecticut. 25 October 2009. Anon. What's the harm in going to a chiropractor? What's the Harm 2009; http://whatstheharm.net/chiropractic.html (accessed October 2009). Ernst E. Vascular accidents after neck manipulation: cause or coincidence? Int J Clin Pract 2009; in press. Long PH. Stroke and spinal manipulation. J Quality Health Care 2004; 3: 8–10. Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage 2008; 35: 544–62. Stevinson C, Honan W, Cooke B, Ernst E. Neurological complications of cervical spine manipulation. J Roy Soc Med 2001; 94: 107–10. Ernst E. Cerebrovascular complications associated with spinal manipulation. Phys Ther Rev 2004; 9: 5–15. Terrett AGJ. Current Concepts in Vertebrobasilar Complications following Spinal Manipulation, 2nd edn. Des Moines: JCMIC Group, 2001. Di Fabio RP. Manipulation of the cervical spine: risks and benefits. Physical Ther 1999; 79: 50–65. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore (NY) 2009; 5: 290–5. Sweeney A, Doody C Manual therapy for the cervical spine and reported adverse effects: a survey of Irish Manipulative Physiotherapists. Man Ther 2010; 15: 32–6. Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011  Again, what "I" have said is that I have been twisting necks for 20+ years with out killing anyone, without hurting anyone, and without even one single complaint, and in the process have helped countless people with pain, muscle tension, headaches, neuropathy, avoid spinal surgery, etc, etc, etc.... And, the "scare media" has not given me one solid reason to stop. So....again...if a technique WORKS, does something that light force CANNOT DO, and is safer than walking across the street...why should we stop using it? Because, to be honest, this is starting to sound like a "personal vendetta" against manual adjusting (in favor of light force technique), rather than a "reasoned" assessment of the risk rewards of manual adjusting. (:-) M. s, D.C. Chiropractic deaths Docs:I especially like their "Conclusion."Lyndon McGill, D.C.Salem, Oregonwww.SalemSpineClinic.comwww.EvolvingDaily.com <Wiley_pub2-logo-2lines.gif> Deaths after Chiropractic: A Review of Published Cases E. Ernst Posted: 08/30/2010; Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing Abstract and Introduction Abstract Objective: The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death.Design: This study is a systematic review of case reports.Methods: Literature searches in four electronic databases with no restrictions of time or language.Main outcome measure: Death.Results: Twenty six fatalities were published in the medical literature and many more might have remained unpublished. The alleged pathology usually was a vascular accident involving the dissection of a vertebral artery.Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit. Introduction Vascular accidents after upper spinal manipulation are a well-recognised problem (e.g.[1,2]). Dissection of a vertebral artery, caused by extension and rotation of the neck beyond the physiological range of motion, is thought to be the underlying mechanism.[2] Several deaths have been reported as a consequence. Some proponents of chiropractic seem to believe that the critical evaluation of this evidence amounts to a 'scare story' (Chairman of the UK General Chiropractic Council)[3] or to 'puffing up (the evidence) out of all proportion' (President of the British Chiropractic Association).[4] A responsible approach to serious therapeutic risks, however, requires an open discussion of the facts. In this review, I aimed to provide the basis for such a discussion by summarising all fatalities which occurred after chiropractic spinal manipulation and were published in the medical literature. Methods Electronic searches were conducted in the following electronic databases: Medline, Embase, AMED, Cochrane Library (September 2009). No restrictions of time or language were applied. Search terms were chiropractic, spinal manipulation, vascular accidents, stroke, death and fatality. In addition, our own departmental files and the bibliographies of the articles thus located were searched. Several experts were also contacted for further data. Case reports were included if they provided information on human patients who had died after receiving one or more treatments from a chiropractor. Data were extracted from the included articles according to predefined criteria (Table 1). Table 1. Published case reports of deaths after chiropractic treatments References Year of publication Victim Type of vascular accident Time between treatment and death Anon[5] 1934 Woman, age unknown Tear in left lateral sinus 2 weeks Pratt- and Berger[6] 1947 32-year-old man Thrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries 24 h Pratt- and Berger[6] 1947 35-year-old woman Thrombosis of posterior-inferior cerebellar artery 10 h Anon[7] 1955 Woman, age unknown Intra-spinal bleeding and compression of spinal cord 18 h Ford and [8] 1956 37-year-old man Thrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries 6 h Ford and [8] 1956 No information provided Thrombosis of basilar artery No information provided and Estridge[9] 1962 33-year-old woman Infarct of cerebellar and brainstem 3 days Lorenz and Vogelsang[10] 1972 39-year-old woman Thrombosis of basilar artery 58 days Schmitt[11] 1976 35-years-old woman Infarct of brainstem 1 h Krueger and Okazaki[12] 1980 25-year-old man Infarct of brainstem and cerebellum 48 h Sherman et al.[13] 1981 60-year-old woman Dissection of vertebral artery 4 days Ali Cherif et al.[14] 1983 51-year-old man Infarct of medulla oblongata 11 days Nielsen[15] 1984 34-year-old man Dissection of vertebral artery aneurysen 3 h Zak and Carmody[16] 1984 53-year-old man Left vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction 27 days Modde[17] 1985 26-year-old woman Dissection of vertebral artery 1 day Jentzen et al.[18] 1987 51-year-old man Infarct of cerebellum and brainstem No information provided Sherman et al.[20] 1987 37-year-old man Infarct of brainstem 3 days Mas et al.[19] 1989 35-year-old woman Dissecting aneurysm of vertebral artery 16 h Raskind and North[21] 1990 47-year-old woman Cerebellar haemorrheae No information provided Sullivan[22] 1992 41-year-old woman Haemorrhage in ventricular system 8 h Haynes[23] 1994 36-year-old woman Dissecting aneurysm of vertebral artery, thrombo-embolism No information provided s et al.[24] 1995 29-year-old woman Infarct of right hemisphere 3 days Klougart et al.[25] 1996 34-year-old man Unclear Few hours Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Dziewas et al.[27] 2003 No information provided No information provided No information provided Results Twenty-six fatalities were published since 1934 in 23 articles (Table 1).[5–27] Table 1. Published case reports of deaths after chiropractic treatments References Year of publication Victim Type of vascular accident Time between treatment and death Anon[5] 1934 Woman, age unknown Tear in left lateral sinus 2 weeks Pratt- and Berger[6] 1947 32-year-old man Thrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries 24 h Pratt- and Berger[6] 1947 35-year-old woman Thrombosis of posterior-inferior cerebellar artery 10 h Anon[7] 1955 Woman, age unknown Intra-spinal bleeding and compression of spinal cord 18 h Ford and [8] 1956 37-year-old man Thrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries 6 h Ford and [8] 1956 No information provided Thrombosis of basilar artery No information provided and Estridge[9] 1962 33-year-old woman Infarct of cerebellar and brainstem 3 days Lorenz and Vogelsang[10] 1972 39-year-old woman Thrombosis of basilar artery 58 days Schmitt[11] 1976 35-years-old woman Infarct of brainstem 1 h Krueger and Okazaki[12] 1980 25-year-old man Infarct of brainstem and cerebellum 48 h Sherman et al.[13] 1981 60-year-old woman Dissection of vertebral artery 4 days Ali Cherif et al.[14] 1983 51-year-old man Infarct of medulla oblongata 11 days Nielsen[15] 1984 34-year-old man Dissection of vertebral artery aneurysen 3 h Zak and Carmody[16] 1984 53-year-old man Left vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction 27 days Modde[17] 1985 26-year-old woman Dissection of vertebral artery 1 day Jentzen et al.[18] 1987 51-year-old man Infarct of cerebellum and brainstem No information provided Sherman et al.[20] 1987 37-year-old man Infarct of brainstem 3 days Mas et al.[19] 1989 35-year-old woman Dissecting aneurysm of vertebral artery 16 h Raskind and North[21] 1990 47-year-old woman Cerebellar haemorrheae No information provided Sullivan[22] 1992 41-year-old woman Haemorrhage in ventricular system 8 h Haynes[23] 1994 36-year-old woman Dissecting aneurysm of vertebral artery, thrombo-embolism No information provided s et al.[24] 1995 29-year-old woman Infarct of right hemisphere 3 days Klougart et al.[25] 1996 34-year-old man Unclear Few hours Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Dziewas et al.[27] 2003 No information provided No information provided No information provided Most of the victims were relatively young; 14 were below the age of 40. There was a slight majority of female patients. The type of complication associated with death frequently related to a vascular accident leading to thrombosis and cerebral infarction. The time between treatment and death ranged from 1 h to 58 days; in 10 cases, it was 1 day or less. Unfortunately, the published information was often incomplete. Many other fatalities seem to have remained unpublished. For instance, the testimony of the chiropractor Preston Long for a court in Connecticut recently listed the family names of nine victims: Mathiason, Solsbury, Mc Cornick, Venegas, Bedenbaugh, , Fawcett, Parisien, Standt. Long also states that 'many others [are] unknown hidden behind legal agreements of silence'.[28] A website names further North American fatalities: Epping (California), G. Fowden (Utah), Grainger (Alberta), Hoffman (land), Renate Dora Labonte (Ontario), (California), Pereyra (Connecticut), A. Roth (Ontario) and Lee Strohecker (Pennsylvania).[29] Discussion This systematic review demonstrates that numerous deaths have been associated with chiropractic. Usually high-velocity, short-lever thrusts of the upper spine with rotation are implicated. They are believed to cause vertebral arterial dissection in predisposed individuals which, in turn, can lead to a chain of events including stroke and death.[1,2,26,30] Many chiropractors claim that, because arterial dissection can also occur spontaneously, causality between the chiropractic intervention and arterial dissection is not proven. However, when carefully evaluating the known facts, one does arrive at the conclusion that causality is at least likely (e.g.[30,31]). Even if it were merely a remote possibility, the precautionary principle in healthcare would mean that neck manipulations should be considered unsafe until proven otherwise. Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition.[32] Thus, the risk-benefit balance for chiropractic neck manipulation fails to be positive. Reliable estimates of the frequency of vascular accidents are prevented by the fact that under-reporting is known to be substantial. In a survey of UK neurologists, for instance, under-reporting of serious complications was 100%.[33] Those cases which are published often turn out to be incomplete. Of 40 case reports of serious adverse effects associated with spinal manipulation, nine failed to provide any information about the clinical outcome.[34] Incomplete reporting of outcomes might therefore further increase the true number of fatalities. Obviously, the present article is not aimed at providing incidence figures; this would require a different methodology entirely. To date, no reliable incidence data are available. This review is focussed on deaths after chiropractic, yet neck manipulations are, of course, used by other healthcare professionals as well. The reason for this focus is simple: chiropractors are more frequently associated with serious manipulation-related adverse effects than osteopaths, physiotherapists, doctors or other professionals. Of the 40 cases of serious adverse effects mentioned above, 28 can be traced back to a chiropractor and none to an osteopath.[34] A review of complications after spinal manipulations by any type of healthcare professional included three deaths related to osteopaths, nine to medical practitioners, none to a physiotherapist, one to a naturopath and 17 to chiropractors.[35] This article also summarised a total of 265 vascular accidents of which 142 were linked to chiropractors. Another review of complications after neck manipulations published by 1997 included 177 vascular accidents, 32 of which were fatal. The vast majority of these cases were associated with chiropractic and none with physiotherapy.[36] The most obvious explanation for the dominance of chiropractic is that chiropractors routinely employ high-velocity, short-lever thrusts on the upper spine with a rotational element, while the other healthcare professionals use them much more sparingly.[37,38] In conclusion, numerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly. Sidebar What's Known Chiropractic upper spinal manipulation has repeatedly been associated with arterial dissection followed by stroke and, in some cases, death. What's New The article is the first systematic review of all fatalities reported in the medical literature. Twenty-six deaths are on record and many more seem to have remained unpublished. References Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100: 330–8. Leon- A, Cuetter A, Ferrer G. Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J 2007; 100: 201–3. Dixon P. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. BJ. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. Anon. Medicolegal. Malpractice: death resulting from chiropractic treatment for headache. J Am Med Assoc 1934; 103:1260, 1935; 105:1712–4, 1937; 109:233–4. Pratt- HR, Berger KE. Cerebellar and spinal injuries after chiropractic manipulation. J Am Med Assoc 1947; 133: 600–3. Anon. Medicolegal abstracts. Chiropractors: injury to spinal meninges during adjustments. J Am Med Assoc 1955; 159: 809. Ford FR, D. Thrombosis of the basilar artery with softenings in the cerebellum and brain stem due to manipulation of the neck; a report of two cases with one post-mortem examination, reasons are given to prove that damage to the vertebral arteries is responsible. Bull s Hopkins Hosp 1956; 98: 37–42. RA, Estridge MN. Neurologic complications of head and neck manipulations. JAMA 1962; 182: 528–31. Lorenz R, Vogelsang HG. Thrombosis of the basilar artery following chiropractic manipulation of the cervical spine. [in German] Thrombose der arteria basilaris nach chiropraktischen Manipulationen an der Halbwirbelsäule. Dtsch Med Wochenschr 1972; 97: 36–43. Schmitt HP. Rupturen und Thrombosen der Arteria vertebralis nach gedeckten mechanischen Insulten. Schweiz Arch Neurol Neurochir Psychiatry 1976; 119: 363–79. Krueger BR, Okazaki H. Vertebral-basilar distribution infarction following chiropractic cervical manipulation. Mayo Clin Proc 1980; 55: 322–32. Sherman DG, Hart RG, Easton JD. Abrupt change in head position and cerebral infarction. Stroke 1981; 12: 2–6. Ali Cherif A, Delpuech F, Habib M, Salamon G, Khalil R. Thrombose vertebro-basilaire apres manipulation du rachis cervical. A propos de deux cas. Ann de Med Phys 1983; 25: 459–65. Nielsen AA. Cerebrovascular insults caused by manipulation of the cervical spine. [in Danish]. Ugeskr Laeger 1984; 146: 3267–70. Zak SM, Carmody RF. Cerebellar infarction from chiropractic neck manipulation: case report and review of the literature. Ariz Med 1984; 41: 333–7. Modde PJ. Chiropractic Malpractice. Columbia, land: Hanrow Press. 1985: 269–70, 273–5, 311–8, 322–3, 329–31, 334–7. Jentzen JM, Amatuzio J, GF. Complications of cervical manipulation: a case report of fatal brainstem infarct with review of the mechanisms and predisposing factors. J Forensic Sci 1987; 32: 1089–94. Mas JL, Henin D, Bousser MG, Chain F, Haw JJ. Dissecting aneurysm of the vertebral artery and cervical manipulation: a case report with autopsy. Neurology 1989; 39: 512–5. Sherman MR, Smialek JE, Zane WE. Pathogenesis of vertebral artery occlusion following cervical spine manipulation. Arch Pathol Lab Med 1987; 111: 851–3. Raskind R, North CM. Vertebral artery injuries following chiropractic cervical spine manipulation--case reports. Angiology 1990; 41: 445–52. Sullivan EC. Brain stem stroke syndromes from cervical adjustments. Report on five cases. J Chiropr Res Clin Invest 1992; 8: 12–6. Haynes MJ. Stroke following cervical manipulation in Perth. Chiropr J Aust 1994; 24: 42–6. s M, Bohl J, Thömke F, Kallen K-J, Mahlzahn K, Wandel E. Dissection of the internal carotid artery after chiropractic manipulation of the neck. Neurology 1995; 45: 2284–6. Klougart N, Leboeuf-Yde C, Rasmussen LR. Safety in chiropractic practice. Part I. The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978–1988. J Manipulative Physiol Ther 1996; 19: 371–7. Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation. Spine 2002; 27: 49–55. Dziewas R, Konrad C, Dräger B et al. Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 2003; 250: 1179–84. Presentation by Dr Preston Long DC to State of Connecticut. Connecticut State Board of Chiropractic Examiners. Hartford Connecticut. 25 October 2009. Anon. What's the harm in going to a chiropractor? What's the Harm 2009; http://whatstheharm.net/chiropractic.html (accessed October 2009). Ernst E. Vascular accidents after neck manipulation: cause or coincidence? Int J Clin Pract 2009; in press. Long PH. Stroke and spinal manipulation. J Quality Health Care 2004; 3: 8–10. Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage 2008; 35: 544–62. Stevinson C, Honan W, Cooke B, Ernst E. Neurological complications of cervical spine manipulation. J Roy Soc Med 2001; 94: 107–10. Ernst E. Cerebrovascular complications associated with spinal manipulation. Phys Ther Rev 2004; 9: 5–15. Terrett AGJ. Current Concepts in Vertebrobasilar Complications following Spinal Manipulation, 2nd edn. Des Moines: JCMIC Group, 2001. Di Fabio RP. Manipulation of the cervical spine: risks and benefits. Physical Ther 1999; 79: 50–65. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore (NY) 2009; 5: 290–5. Sweeney A, Doody C Manual therapy for the cervical spine and reported adverse effects: a survey of Irish Manipulative Physiotherapists. Man Ther 2010; 15: 32–6. Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 Well said, and lets get something straight: Chiropractic manipulation is an art form performed with the hands. It's why I got into the profession. Cervical Manipulation should use as little rotation as possible. When I adjust the neck, I notice I use very little rotation. Just as one feels that they are complying and acquiescing to the fears of the public, I feel I'm delivering what the public Wants and Needs. They come saying they want a REAL chiropractic adjustment far more than they are looking for "light force". Those that are looking for the doctor to use tools, and apparatus to perform the adjustments are in the large minority and in fact are perfectly satisfied with my skilled hands (tooting own horn). Abandoning manual adjustments is junk, paranoia, not chiropractic and will never happen. Lets move on, develop the SKILL effectively or refer to a chiro that can do it with a high level of effectiveness. Being a Great manual adjuster should be the goal of all of us. The suggestion of abandoning this art form is a slap in the face to those of us who have honed this skill. I would have never become a chiropractor if my experience with chiropractic was with the doctor adjusting me with a tool. ph Medlin D.C. From: M. s, D.C. Sent: Wednesday, July 13, 2011 9:46 AM Oregondcs Subject: Fw: Chiropractic deaths  Again, what "I" have said is that I have been twisting necks for 20+ years with out killing anyone, without hurting anyone, and without even one single complaint, and in the process have helped countless people with pain, muscle tension, headaches, neuropathy, avoid spinal surgery, etc, etc, etc.... And, the "scare media" has not given me one solid reason to stop. So....again...if a technique WORKS, does something that light force CANNOT DO, and is safer than walking across the street...why should we stop using it? Because, to be honest, this is starting to sound like a "personal vendetta" against manual adjusting (in favor of light force technique), rather than a "reasoned" assessment of the risk rewards of manual adjusting. (:-) M. s, D.C. Chiropractic deaths Docs:I especially like their "Conclusion."Lyndon McGill, D.C.Salem, Oregonwww.SalemSpineClinic.comwww.EvolvingDaily.com <Wiley_pub2-logo-2lines.gif> Deaths after Chiropractic: A Review of Published Cases E. Ernst Posted: 08/30/2010; Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing Abstract and Introduction Abstract Objective: The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death.Design: This study is a systematic review of case reports.Methods: Literature searches in four electronic databases with no restrictions of time or language.Main outcome measure: Death.Results: Twenty six fatalities were published in the medical literature and many more might have remained unpublished. The alleged pathology usually was a vascular accident involving the dissection of a vertebral artery.Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit. Introduction Vascular accidents after upper spinal manipulation are a well-recognised problem (e.g.[1,2]). Dissection of a vertebral artery, caused by extension and rotation of the neck beyond the physiological range of motion, is thought to be the underlying mechanism.[2] Several deaths have been reported as a consequence. Some proponents of chiropractic seem to believe that the critical evaluation of this evidence amounts to a 'scare story' (Chairman of the UK General Chiropractic Council)[3] or to 'puffing up (the evidence) out of all proportion' (President of the British Chiropractic Association).[4] A responsible approach to serious therapeutic risks, however, requires an open discussion of the facts. In this review, I aimed to provide the basis for such a discussion by summarising all fatalities which occurred after chiropractic spinal manipulation and were published in the medical literature. Methods Electronic searches were conducted in the following electronic databases: Medline, Embase, AMED, Cochrane Library (September 2009). No restrictions of time or language were applied. Search terms were chiropractic, spinal manipulation, vascular accidents, stroke, death and fatality. In addition, our own departmental files and the bibliographies of the articles thus located were searched. Several experts were also contacted for further data. Case reports were included if they provided information on human patients who had died after receiving one or more treatments from a chiropractor. Data were extracted from the included articles according to predefined criteria (Table 1). Table 1. Published case reports of deaths after chiropractic treatments References Year of publication Victim Type of vascular accident Time between treatment and death Anon[5] 1934 Woman, age unknown Tear in left lateral sinus 2 weeks Pratt- and Berger[6] 1947 32-year-old man Thrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries 24 h Pratt- and Berger[6] 1947 35-year-old woman Thrombosis of posterior-inferior cerebellar artery 10 h Anon[7] 1955 Woman, age unknown Intra-spinal bleeding and compression of spinal cord 18 h Ford and [8] 1956 37-year-old man Thrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries 6 h Ford and [8] 1956 No information provided Thrombosis of basilar artery No information provided and Estridge[9] 1962 33-year-old woman Infarct of cerebellar and brainstem 3 days Lorenz and Vogelsang[10] 1972 39-year-old woman Thrombosis of basilar artery 58 days Schmitt[11] 1976 35-years-old woman Infarct of brainstem 1 h Krueger and Okazaki[12] 1980 25-year-old man Infarct of brainstem and cerebellum 48 h Sherman et al.[13] 1981 60-year-old woman Dissection of vertebral artery 4 days Ali Cherif et al.[14] 1983 51-year-old man Infarct of medulla oblongata 11 days Nielsen[15] 1984 34-year-old man Dissection of vertebral artery aneurysen 3 h Zak and Carmody[16] 1984 53-year-old man Left vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction 27 days Modde[17] 1985 26-year-old woman Dissection of vertebral artery 1 day Jentzen et al.[18] 1987 51-year-old man Infarct of cerebellum and brainstem No information provided Sherman et al.[20] 1987 37-year-old man Infarct of brainstem 3 days Mas et al.[19] 1989 35-year-old woman Dissecting aneurysm of vertebral artery 16 h Raskind and North[21] 1990 47-year-old woman Cerebellar haemorrheae No information provided Sullivan[22] 1992 41-year-old woman Haemorrhage in ventricular system 8 h Haynes[23] 1994 36-year-old woman Dissecting aneurysm of vertebral artery, thrombo-embolism No information provided s et al.[24] 1995 29-year-old woman Infarct of right hemisphere 3 days Klougart et al.[25] 1996 34-year-old man Unclear Few hours Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Dziewas et al.[27] 2003 No information provided No information provided No information provided Results Twenty-six fatalities were published since 1934 in 23 articles (Table 1).[5–27] Table 1. Published case reports of deaths after chiropractic treatments References Year of publication Victim Type of vascular accident Time between treatment and death Anon[5] 1934 Woman, age unknown Tear in left lateral sinus 2 weeks Pratt- and Berger[6] 1947 32-year-old man Thrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries 24 h Pratt- and Berger[6] 1947 35-year-old woman Thrombosis of posterior-inferior cerebellar artery 10 h Anon[7] 1955 Woman, age unknown Intra-spinal bleeding and compression of spinal cord 18 h Ford and [8] 1956 37-year-old man Thrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries 6 h Ford and [8] 1956 No information provided Thrombosis of basilar artery No information provided and Estridge[9] 1962 33-year-old woman Infarct of cerebellar and brainstem 3 days Lorenz and Vogelsang[10] 1972 39-year-old woman Thrombosis of basilar artery 58 days Schmitt[11] 1976 35-years-old woman Infarct of brainstem 1 h Krueger and Okazaki[12] 1980 25-year-old man Infarct of brainstem and cerebellum 48 h Sherman et al.[13] 1981 60-year-old woman Dissection of vertebral artery 4 days Ali Cherif et al.[14] 1983 51-year-old man Infarct of medulla oblongata 11 days Nielsen[15] 1984 34-year-old man Dissection of vertebral artery aneurysen 3 h Zak and Carmody[16] 1984 53-year-old man Left vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction 27 days Modde[17] 1985 26-year-old woman Dissection of vertebral artery 1 day Jentzen et al.[18] 1987 51-year-old man Infarct of cerebellum and brainstem No information provided Sherman et al.[20] 1987 37-year-old man Infarct of brainstem 3 days Mas et al.[19] 1989 35-year-old woman Dissecting aneurysm of vertebral artery 16 h Raskind and North[21] 1990 47-year-old woman Cerebellar haemorrheae No information provided Sullivan[22] 1992 41-year-old woman Haemorrhage in ventricular system 8 h Haynes[23] 1994 36-year-old woman Dissecting aneurysm of vertebral artery, thrombo-embolism No information provided s et al.[24] 1995 29-year-old woman Infarct of right hemisphere 3 days Klougart et al.[25] 1996 34-year-old man Unclear Few hours Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Haldeman et al.[26] 2002 Previously unpublished legal cases No information provided No information provided Dziewas et al.[27] 2003 No information provided No information provided No information provided Most of the victims were relatively young; 14 were below the age of 40. There was a slight majority of female patients. The type of complication associated with death frequently related to a vascular accident leading to thrombosis and cerebral infarction. The time between treatment and death ranged from 1 h to 58 days; in 10 cases, it was 1 day or less. Unfortunately, the published information was often incomplete. Many other fatalities seem to have remained unpublished. For instance, the testimony of the chiropractor Preston Long for a court in Connecticut recently listed the family names of nine victims: Mathiason, Solsbury, Mc Cornick, Venegas, Bedenbaugh, , Fawcett, Parisien, Standt. Long also states that 'many others [are] unknown hidden behind legal agreements of silence'.[28] A website names further North American fatalities: Epping (California), G. Fowden (Utah), Grainger (Alberta), Hoffman (land), Renate Dora Labonte (Ontario), (California), Pereyra (Connecticut), A. Roth (Ontario) and Lee Strohecker (Pennsylvania).[29] Discussion This systematic review demonstrates that numerous deaths have been associated with chiropractic. Usually high-velocity, short-lever thrusts of the upper spine with rotation are implicated. They are believed to cause vertebral arterial dissection in predisposed individuals which, in turn, can lead to a chain of events including stroke and death.[1,2,26,30] Many chiropractors claim that, because arterial dissection can also occur spontaneously, causality between the chiropractic intervention and arterial dissection is not proven. However, when carefully evaluating the known facts, one does arrive at the conclusion that causality is at least likely (e.g.[30,31]). Even if it were merely a remote possibility, the precautionary principle in healthcare would mean that neck manipulations should be considered unsafe until proven otherwise. Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition.[32] Thus, the risk-benefit balance for chiropractic neck manipulation fails to be positive. Reliable estimates of the frequency of vascular accidents are prevented by the fact that under-reporting is known to be substantial. In a survey of UK neurologists, for instance, under-reporting of serious complications was 100%.[33] Those cases which are published often turn out to be incomplete. Of 40 case reports of serious adverse effects associated with spinal manipulation, nine failed to provide any information about the clinical outcome.[34] Incomplete reporting of outcomes might therefore further increase the true number of fatalities. Obviously, the present article is not aimed at providing incidence figures; this would require a different methodology entirely. To date, no reliable incidence data are available. This review is focussed on deaths after chiropractic, yet neck manipulations are, of course, used by other healthcare professionals as well. The reason for this focus is simple: chiropractors are more frequently associated with serious manipulation-related adverse effects than osteopaths, physiotherapists, doctors or other professionals. Of the 40 cases of serious adverse effects mentioned above, 28 can be traced back to a chiropractor and none to an osteopath.[34] A review of complications after spinal manipulations by any type of healthcare professional included three deaths related to osteopaths, nine to medical practitioners, none to a physiotherapist, one to a naturopath and 17 to chiropractors.[35] This article also summarised a total of 265 vascular accidents of which 142 were linked to chiropractors. Another review of complications after neck manipulations published by 1997 included 177 vascular accidents, 32 of which were fatal. The vast majority of these cases were associated with chiropractic and none with physiotherapy.[36] The most obvious explanation for the dominance of chiropractic is that chiropractors routinely employ high-velocity, short-lever thrusts on the upper spine with a rotational element, while the other healthcare professionals use them much more sparingly.[37,38] In conclusion, numerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly. Sidebar What's Known Chiropractic upper spinal manipulation has repeatedly been associated with arterial dissection followed by stroke and, in some cases, death. What's New The article is the first systematic review of all fatalities reported in the medical literature. Twenty-six deaths are on record and many more seem to have remained unpublished. References Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100: 330–8. Leon- A, Cuetter A, Ferrer G. Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J 2007; 100: 201–3. Dixon P. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. BJ. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. Anon. Medicolegal. Malpractice: death resulting from chiropractic treatment for headache. J Am Med Assoc 1934; 103:1260, 1935; 105:1712–4, 1937; 109:233–4. Pratt- HR, Berger KE. Cerebellar and spinal injuries after chiropractic manipulation. J Am Med Assoc 1947; 133: 600–3. Anon. Medicolegal abstracts. Chiropractors: injury to spinal meninges during adjustments. J Am Med Assoc 1955; 159: 809. Ford FR, D. Thrombosis of the basilar artery with softenings in the cerebellum and brain stem due to manipulation of the neck; a report of two cases with one post-mortem examination, reasons are given to prove that damage to the vertebral arteries is responsible. Bull s Hopkins Hosp 1956; 98: 37–42. RA, Estridge MN. Neurologic complications of head and neck manipulations. JAMA 1962; 182: 528–31. Lorenz R, Vogelsang HG. Thrombosis of the basilar artery following chiropractic manipulation of the cervical spine. [in German] Thrombose der arteria basilaris nach chiropraktischen Manipulationen an der Halbwirbelsäule. Dtsch Med Wochenschr 1972; 97: 36–43. Schmitt HP. Rupturen und Thrombosen der Arteria vertebralis nach gedeckten mechanischen Insulten. Schweiz Arch Neurol Neurochir Psychiatry 1976; 119: 363–79. Krueger BR, Okazaki H. Vertebral-basilar distribution infarction following chiropractic cervical manipulation. Mayo Clin Proc 1980; 55: 322–32. Sherman DG, Hart RG, Easton JD. Abrupt change in head position and cerebral infarction. Stroke 1981; 12: 2–6. Ali Cherif A, Delpuech F, Habib M, Salamon G, Khalil R. Thrombose vertebro-basilaire apres manipulation du rachis cervical. A propos de deux cas. Ann de Med Phys 1983; 25: 459–65. Nielsen AA. Cerebrovascular insults caused by manipulation of the cervical spine. [in Danish]. Ugeskr Laeger 1984; 146: 3267–70. Zak SM, Carmody RF. Cerebellar infarction from chiropractic neck manipulation: case report and review of the literature. Ariz Med 1984; 41: 333–7. Modde PJ. Chiropractic Malpractice. Columbia, land: Hanrow Press. 1985: 269–70, 273–5, 311–8, 322–3, 329–31, 334–7. Jentzen JM, Amatuzio J, GF. Complications of cervical manipulation: a case report of fatal brainstem infarct with review of the mechanisms and predisposing factors. J Forensic Sci 1987; 32: 1089–94. Mas JL, Henin D, Bousser MG, Chain F, Haw JJ. Dissecting aneurysm of the vertebral artery and cervical manipulation: a case report with autopsy. Neurology 1989; 39: 512–5. Sherman MR, Smialek JE, Zane WE. Pathogenesis of vertebral artery occlusion following cervical spine manipulation. Arch Pathol Lab Med 1987; 111: 851–3. Raskind R, North CM. Vertebral artery injuries following chiropractic cervical spine manipulation--case reports. Angiology 1990; 41: 445–52. Sullivan EC. Brain stem stroke syndromes from cervical adjustments. Report on five cases. J Chiropr Res Clin Invest 1992; 8: 12–6. Haynes MJ. Stroke following cervical manipulation in Perth. Chiropr J Aust 1994; 24: 42–6. s M, Bohl J, Thömke F, Kallen K-J, Mahlzahn K, Wandel E. Dissection of the internal carotid artery after chiropractic manipulation of the neck. Neurology 1995; 45: 2284–6. Klougart N, Leboeuf-Yde C, Rasmussen LR. Safety in chiropractic practice. Part I. The occurrence of cerebrovascular accidents after manipulation to the neck in Denmark from 1978–1988. J Manipulative Physiol Ther 1996; 19: 371–7. Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation. Spine 2002; 27: 49–55. Dziewas R, Konrad C, Dräger B et al. Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 2003; 250: 1179–84. Presentation by Dr Preston Long DC to State of Connecticut. Connecticut State Board of Chiropractic Examiners. Hartford Connecticut. 25 October 2009. Anon. What's the harm in going to a chiropractor? What's the Harm 2009; http://whatstheharm.net/chiropractic.html (accessed October 2009). Ernst E. Vascular accidents after neck manipulation: cause or coincidence? Int J Clin Pract 2009; in press. Long PH. Stroke and spinal manipulation. J Quality Health Care 2004; 3: 8–10. Ernst E. Chiropractic: a critical evaluation. J Pain Symptom Manage 2008; 35: 544–62. Stevinson C, Honan W, Cooke B, Ernst E. Neurological complications of cervical spine manipulation. J Roy Soc Med 2001; 94: 107–10. Ernst E. Cerebrovascular complications associated with spinal manipulation. Phys Ther Rev 2004; 9: 5–15. Terrett AGJ. Current Concepts in Vertebrobasilar Complications following Spinal Manipulation, 2nd edn. Des Moines: JCMIC Group, 2001. Di Fabio RP. Manipulation of the cervical spine: risks and benefits. Physical Ther 1999; 79: 50–65. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore (NY) 2009; 5: 290–5. Sweeney A, Doody C Manual therapy for the cervical spine and reported adverse effects: a survey of Irish Manipulative Physiotherapists. Man Ther 2010; 15: 32–6. Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 13, 2011 Report Share Posted July 13, 2011 My four cents worth… to you fine colleagues just as I explained to the young ER doc the other day when he asked, but Vern isn’t it dangerous to manipulation a child?  Or gosh an infant?? He had come in after hours for a locked up sacroiliac joint got a wonderful release…btw way this was a couple of weeks ago one visit and he be fixed.  I replied S……do you really believe I use the same technique on a child or infants SI joint that I used on you? Or say a 290 pound truck driver? He say oh, ya, probably not…laugh…..laugh….first of all any DC worth is salt in my opinion has multiple treatment tools in his or her tool box and uses the tool or tools that are best for that individual patient and their clinical situation. The same is true of the elderly etc……also I always ask a new patient if they have had chiropractic treatment in the past if they say yes I ask, did it help? And if they say yes I ask them what the prior DC did that worked for them…now guess what I do with that intel???? Yes, I duplicate as close as possible what worked in the past for that patient unless something significant has changed clinically that would force me to do something different.  Additionally if a patient comes in and states to staff “Does Dr. Saboe use Activator?â€Â Staff’s answer is yes! If they say I don’t want to be “cracked, it scares the heck out of my cause my uncle Joe….â€Â  Do you really believe I’m going to provide a HVLA adjustment on that person……of course not I’m going to use the tool in my tool box that is best for that patient…..not saying I may not convert them later is clinically indicated…… Lastly, it is indeed HVLA spinal manipulation/adjustments that have the high level clinical studies supporting its efficacy nothing else in our tool box comes close it is in fact safe and effective…..end of me-four cents…..Cheers, Vern SaboeFrom: [mailto: ] On Behalf Of Sunny KierstynSent: Wednesday, July 13, 2011 9:57 AM s, D.C.; Subject: RE: Chiropractic deaths Hi Bob, Hi Herb, Adding my 2 cents at this moment may explode this conversation but ideas need to be expressed. Downtrending the amount of usage of the HVLA would, IMHO, be a boon for us. Learning light force techniques would be smart for all of us to know; personally, in my now 21 years as a DC, I've found only one person I was unable to adjust with a stairstep and that was on a Sunday afternoon afrer a very long hot festival weekend., setting the stage for dehydration to compound the weekend's compaction of the neck. So. light force can do more than many DC credit. The HVLA is necessary and doesn't need to be eliminated but, using it as a last resort, would, again IMHO, bring more people into our offices. That loud crack is fun for some and terrifying for others. We get the others into our office. This week I've seen three 'virgins' .... all over 60 and all who state that they stayed away becuase of 'what they heard from others' about the forcefulness. That crack often seems to shoot us more in the foot than teach people how good it can feel afterwards. Plus, what I watch DC ignore is the state of dehydration of the disc that the noise can intimate. We still have areas we need to clean up inorder for the public to be comfortable with us. my 2 cents this am. Hugs to both of you. SunnySunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com From: drbobdc83@...Date: Wed, 13 Jul 2011 09:46:03 -0700Subject: Fw: Chiropractic deaths  Again, what " I " have said is that I have been twisting necks for 20+ years with out killing anyone, without hurting anyone, and without even one single complaint, and in the process have helped countless people with pain, muscle tension, headaches, neuropathy, avoid spinal surgery, etc, etc, etc.... And, the " scare media " has not given me one solid reason to stop. So....again...if a technique WORKS, does something that light force CANNOT DO, and is safer than walking across the street...why should we stop using it? Because, to be honest, this is starting to sound like a " personal vendetta " against manual adjusting (in favor of light force technique), rather than a " reasoned " assessment of the risk rewards of manual adjusting. (:-) M. s, D.C. Chiropractic deaths Docs:I especially like their " Conclusion. " Lyndon McGill, D.C.Salem, Oregonwww.SalemSpineClinic.comwww.EvolvingDaily.com <Wiley_pub2-logo-2lines.gif> Deaths after Chiropractic: A Review of Published CasesE. ErnstPosted: 08/30/2010; Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell PublishingAbstract and IntroductionAbstractObjective: The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death.Design: This study is a systematic review of case reports.Methods: Literature searches in four electronic databases with no restrictions of time or language.Main outcome measure: Death.Results: Twenty six fatalities were published in the medical literature and many more might have remained unpublished. The alleged pathology usually was a vascular accident involving the dissection of a vertebral artery.Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.IntroductionVascular accidents after upper spinal manipulation are a well-recognised problem (e.g.[1,2]). Dissection of a vertebral artery, caused by extension and rotation of the neck beyond the physiological range of motion, is thought to be the underlying mechanism.[2] Several deaths have been reported as a consequence. Some proponents of chiropractic seem to believe that the critical evaluation of this evidence amounts to a 'scare story' (Chairman of the UK General Chiropractic Council)[3] or to 'puffing up (the evidence) out of all proportion' (President of the British Chiropractic Association).[4] A responsible approach to serious therapeutic risks, however, requires an open discussion of the facts.In this review, I aimed to provide the basis for such a discussion by summarising all fatalities which occurred after chiropractic spinal manipulation and were published in the medical literature.MethodsElectronic searches were conducted in the following electronic databases: Medline, Embase, AMED, Cochrane Library (September 2009). No restrictions of time or language were applied. Search terms were chiropractic, spinal manipulation, vascular accidents, stroke, death and fatality. In addition, our own departmental files and the bibliographies of the articles thus located were searched. Several experts were also contacted for further data. Case reports were included if they provided information on human patients who had died after receiving one or more treatments from a chiropractor. Data were extracted from the included articles according to predefined criteria (Table 1).Table 1. Published case reports of deaths after chiropractic treatmentsReferencesYear of publicationVictimType of vascular accidentTime between treatment and deathAnon[5] 1934Woman, age unknownTear in left lateral sinus2 weeksPratt- and Berger[6] 194732-year-old manThrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries24 hPratt- and Berger[6] 194735-year-old womanThrombosis of posterior-inferior cerebellar artery10 hAnon[7] 1955Woman, age unknownIntra-spinal bleeding and compression of spinal cord18 hFord and [8] 195637-year-old manThrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries6 hFord and [8] 1956No information providedThrombosis of basilar arteryNo information provided and Estridge[9] 196233-year-old womanInfarct of cerebellar and brainstem3 daysLorenz and Vogelsang[10] 197239-year-old womanThrombosis of basilar artery58 daysSchmitt[11] 197635-years-old womanInfarct of brainstem1 hKrueger and Okazaki[12] 198025-year-old manInfarct of brainstem and cerebellum48 hSherman et al.[13] 198160-year-old womanDissection of vertebral artery4 daysAli Cherif et al.[14] 198351-year-old manInfarct of medulla oblongata11 daysNielsen[15] 198434-year-old manDissection of vertebral artery aneurysen3 hZak and Carmody[16] 198453-year-old manLeft vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction27 daysModde[17] 198526-year-old womanDissection of vertebral artery1 dayJentzen et al.[18] 198751-year-old manInfarct of cerebellum and brainstemNo information providedSherman et al.[20] 198737-year-old manInfarct of brainstem3 daysMas et al.[19] 198935-year-old womanDissecting aneurysm of vertebral artery16 hRaskind and North[21] 199047-year-old womanCerebellar haemorrheaeNo information providedSullivan[22] 199241-year-old womanHaemorrhage in ventricular system8 hHaynes[23] 199436-year-old womanDissecting aneurysm of vertebral artery, thrombo-embolismNo information provideds et al.[24] 199529-year-old womanInfarct of right hemisphere3 daysKlougart et al.[25] 199634-year-old manUnclearFew hoursHaldeman et al.[26] 2002Previously unpublished legal casesNo information providedNo information providedHaldeman et al.[26] 2002Previously unpublished legal casesNo information providedNo information providedDziewas et al.[27] 2003No information providedNo information providedNo information providedResultsTwenty-six fatalities were published since 1934 in 23 articles (Table 1).[5–27] Table 1. Published case reports of deaths after chiropractic treatmentsReferencesYear of publicationVictimType of vascular accidentTime between treatment and deathAnon[5] 1934Woman, age unknownTear in left lateral sinus2 weeksPratt- and Berger[6] 194732-year-old manThrombosis of basilar, left anterior-inferior cerebellar and right posterior-inferior arteries24 hPratt- and Berger[6] 194735-year-old womanThrombosis of posterior-inferior cerebellar artery10 hAnon[7] 1955Woman, age unknownIntra-spinal bleeding and compression of spinal cord18 hFord and [8] 195637-year-old manThrombosis of basilar, left-posterior cerebellar and left-posterior cerebral arteries6 hFord and [8] 1956No information providedThrombosis of basilar arteryNo information provided and Estridge[9] 196233-year-old womanInfarct of cerebellar and brainstem3 daysLorenz and Vogelsang[10] 197239-year-old womanThrombosis of basilar artery58 daysSchmitt[11] 197635-years-old womanInfarct of brainstem1 hKrueger and Okazaki[12] 198025-year-old manInfarct of brainstem and cerebellum48 hSherman et al.[13] 198160-year-old womanDissection of vertebral artery4 daysAli Cherif et al.[14] 198351-year-old manInfarct of medulla oblongata11 daysNielsen[15] 198434-year-old manDissection of vertebral artery aneurysen3 hZak and Carmody[16] 198453-year-old manLeft vertebral, posterior-inferior and superior cerebellar artery occlusion; cerebellar infarction27 daysModde[17] 198526-year-old womanDissection of vertebral artery1 dayJentzen et al.[18] 198751-year-old manInfarct of cerebellum and brainstemNo information providedSherman et al.[20] 198737-year-old manInfarct of brainstem3 daysMas et al.[19] 198935-year-old womanDissecting aneurysm of vertebral artery16 hRaskind and North[21] 199047-year-old womanCerebellar haemorrheaeNo information providedSullivan[22] 199241-year-old womanHaemorrhage in ventricular system8 hHaynes[23] 199436-year-old womanDissecting aneurysm of vertebral artery, thrombo-embolismNo information provideds et al.[24] 199529-year-old womanInfarct of right hemisphere3 daysKlougart et al.[25] 199634-year-old manUnclearFew hoursHaldeman et al.[26] 2002Previously unpublished legal casesNo information providedNo information providedHaldeman et al.[26] 2002Previously unpublished legal casesNo information providedNo information providedDziewas et al.[27] 2003No information providedNo information providedNo information providedMost of the victims were relatively young; 14 were below the age of 40. There was a slight majority of female patients. The type of complication associated with death frequently related to a vascular accident leading to thrombosis and cerebral infarction. The time between treatment and death ranged from 1 h to 58 days; in 10 cases, it was 1 day or less. Unfortunately, the published information was often incomplete.Many other fatalities seem to have remained unpublished. For instance, the testimony of the chiropractor Preston Long for a court in Connecticut recently listed the family names of nine victims: Mathiason, Solsbury, Mc Cornick, Venegas, Bedenbaugh, , Fawcett, Parisien, Standt. Long also states that 'many others [are] unknown hidden behind legal agreements of silence'.[28] A website names further North American fatalities: Epping (California), G. Fowden (Utah), Grainger (Alberta), Hoffman (land), Renate Dora Labonte (Ontario), (California), Pereyra (Connecticut), A. Roth (Ontario) and Lee Strohecker (Pennsylvania).[29] DiscussionThis systematic review demonstrates that numerous deaths have been associated with chiropractic. Usually high-velocity, short-lever thrusts of the upper spine with rotation are implicated. They are believed to cause vertebral arterial dissection in predisposed individuals which, in turn, can lead to a chain of events including stroke and death.[1,2,26,30] Many chiropractors claim that, because arterial dissection can also occur spontaneously, causality between the chiropractic intervention and arterial dissection is not proven. However, when carefully evaluating the known facts, one does arrive at the conclusion that causality is at least likely (e.g.[30,31]). Even if it were merely a remote possibility, the precautionary principle in healthcare would mean that neck manipulations should be considered unsafe until proven otherwise. Moreover, there is no good evidence for assuming that neck manipulation is an effective therapy for any medical condition.[32] Thus, the risk-benefit balance for chiropractic neck manipulation fails to be positive.Reliable estimates of the frequency of vascular accidents are prevented by the fact that under-reporting is known to be substantial. In a survey of UK neurologists, for instance, under-reporting of serious complications was 100%.[33] Those cases which are published often turn out to be incomplete. Of 40 case reports of serious adverse effects associated with spinal manipulation, nine failed to provide any information about the clinical outcome.[34] Incomplete reporting of outcomes might therefore further increase the true number of fatalities. Obviously, the present article is not aimed at providing incidence figures; this would require a different methodology entirely. To date, no reliable incidence data are available.This review is focussed on deaths after chiropractic, yet neck manipulations are, of course, used by other healthcare professionals as well. The reason for this focus is simple: chiropractors are more frequently associated with serious manipulation-related adverse effects than osteopaths, physiotherapists, doctors or other professionals. Of the 40 cases of serious adverse effects mentioned above, 28 can be traced back to a chiropractor and none to an osteopath.[34] A review of complications after spinal manipulations by any type of healthcare professional included three deaths related to osteopaths, nine to medical practitioners, none to a physiotherapist, one to a naturopath and 17 to chiropractors.[35] This article also summarised a total of 265 vascular accidents of which 142 were linked to chiropractors. Another review of complications after neck manipulations published by 1997 included 177 vascular accidents, 32 of which were fatal. The vast majority of these cases were associated with chiropractic and none with physiotherapy.[36] The most obvious explanation for the dominance of chiropractic is that chiropractors routinely employ high-velocity, short-lever thrusts on the upper spine with a rotational element, while the other healthcare professionals use them much more sparingly.[37,38] In conclusion, numerous deaths have been associated with chiropractic neck manipulations. There are reasons to suspect that under-reporting is substantial and reliable incidence figures do not exist. The risks of chiropractic neck manipulations by far outweigh their benefits. Healthcare professionals should advise the public accordingly.SidebarWhat's KnownChiropractic upper spinal manipulation has repeatedly been associated with arterial dissection followed by stroke and, in some cases, death.What's NewThe article is the first systematic review of all fatalities reported in the medical literature. Twenty-six deaths are on record and many more seem to have remained unpublished.ReferencesErnst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100: 330–8. Leon- A, Cuetter A, Ferrer G. Cervical spine manipulation: an alternative medical procedure with potentially fatal complications. South Med J 2007; 100: 201–3. Dixon P. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. BJ. Letter to the Editor. Adverse effects of spinal manipulation. J R Soc Med 2007; 100: 444. Anon. Medicolegal. Malpractice: death resulting from chiropractic treatment for headache. 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Sweeney A, Doody C Manual therapy for the cervical spine and reported adverse effects: a survey of Irish Manipulative Physiotherapists. Man Ther 2010; 15: 32–6. Int J Clin Pract. 2010;64(10):1162-1165. © 2010 Blackwell Publishing Error! Filename not specified. Quote Link to comment Share on other sites More sharing options...
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