BACKGROUND: Circumstances surrounding cerebrovascular accidents after cervical manipulation need further clarification. In particular, more information is needed on the importance of specific techniques.

OBJECTIVES: To estimate the occurrence of cerebrovascular incidents (CVI) after chiropractic treatment to the cervical spine in relation to both the estimated number of treatments given to the upper and lower cervical spine and the techniques used.

DESIGN: Retrospective data were collected from questionnaires covering the period 1978-1988 inclusive; in a second survey, chiropractors provided information obtained through inspection of their own case records.

PARTICIPANTS: All 226 practicing members of the Danish Chiropractors' Association in 1989 (response rate 54%) and a random sample of 40 chiropractors (response rate 72.5%) from the same population were invited to participate in the study.

OUTCOME MEASURES: Survey 1: Estimated proportion of consultations that involved treatment to the cervical spine, number and clinical particulars of CVI. Survey 2: proportion of treatment sessions on a specific day that included the neck, upper/lower neck and the type of treatment (nonrotation or rotation techniques) preferred.

MAIN RESULTS: Among the respondents, the reported incidence of CVI between 1981 and 1988 was about one for every 120,000 cervical treatment sessions, and SMT to the upper neck was about four times more commonly associated with CVI than treatment of the lower neck. Rotation procedures to the upper cervical spine were almost twice as often linked to CVI as nonrotation procedures of that area.

CONCLUSIONS: Although there seems to be a link between upper cervical rotation manipulative techniques and cerebrovascular incidents, treatment to the lower neck and the use of other techniques are implicated as well.

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