Excerpt: Although there has been a putative link between cervical spinal manipulative treatment (cSMT) and cervical artery dissection (CAD) ever since Thornton’s report in the literature in 1934, recent evidence suggests that this is an association rather than a causal relationship. Since 2008, several studies published by Cassidy and co-workers have attributed the association between cSMT and CAD to patients seeking chiropractic care for neck pain and headaches during the prodrome of a stroke.

 

Most reviews in the literature now generally report that there are no convincing data, either to prove or disprove, any causality between cSMT and CAD. However, case reports and case series still accumulate that identify chiropractic as the sole cause of CAD. Furthermore, Tuchin recently tested the causality between CAD and SMT using Hill’s criteria, and concluded that there is no evidence that SMT is causally related to stroke. Nevertheless, some authors continue to claim that cSMT causes CAD.

 

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