This week's think like a doctor column in the NYT is great. It asks the question, if a woman goes to a chiropractor, gets her neck manipulated, and within hours and for the succeeding four years she's had symptoms of severe headaches and a pulsatile sound in her ears, what is the diagnosis?Quack, quack, quack chiropractory!
You can guess what mine is...
Neck manipulation in chiropractic is a known source of serious neurologic injury. An excellent review at sciencebasedmedicine goes over the major issues. Briefly, rapidly turning someone's neck has the potential to cause injury to the vertebral artery as it travels through spinous processes in the neck on the way to the brain, it may cause you to dislodge plaques from those arteries or the carotid causing embolic stroke, it may cause dissections of those arteries, or it may cause local damage to the cervical vertebra or discs. A systematic review of injuries in the literature actually estimates the occurrence of these problems related to manipulation is highly under-reported as they are estimates from case reports in the literature.