Deadly twist: Neck adjustments can be risky

Heck’s vertigo and queasiness after her first appointment should have been red flags because both are symptoms of stroke. Chiropractors should tread carefully and do extra screening tests before manipulating the neck of a patient who complains of unusual dizziness, vertigo or nausea, according to an instructional guide published by National Chiropractic Mutual Insurance Company in Clive, Iowa, the nation’s largest chiropractic insurer. “A good chiropractor doesn’t merely grab people’s necks and crack them,” the ACA’s Lauretti says. “You take a thorough exam. If there is a history of dizziness, stroke, visual or auditory disturbances, and to a certain extent a history of migraine, I’m going to be much more cautious.”

Wade S. Smith, M.D., director of the Neuro-vascular Service at the University of California at San Francisco, was the lead author of a 2003 study in the journal Neurology that confirmed the connection between cervical manipulation and stroke. In the study, Dr. Smith says, patients with strokes caused by torn arteries were nearly five times more likely to have had a recent neck adjustment than those with strokes caused by something else, indicating that “recently seeing a chiropractor is an independent risk factor for stroke.”

And although researchers aren’t sure why, young women tend to have slightly more of the injuries. Brittmarie Harwe, 40, of Wethersfield, Connecticut, received an out-of-court settlement of $900,000 after a 1993 manipulation that permanently paralyzed one of her vocal cords and left her unable to swallow food; she nourishes herself through a stomach tube. In December 2006, Rachelle Smith, a 32-year-old mother of five in Olathe, Kansas, settled a case with her chiropractor for undisclosed damages and $70,000 in medical costs. She says that when she began to vomit after a neck adjustment — a sign of what would turn out to be a stroke — the chiropractor assured her that her body was simply “releasing toxins.”

“I’ve seen more cases of vascular injury following chiropractic manipulations than just about anybody, and these people’s lives are ruined,” says Alan Bragman, an Atlanta chiropractor who has served as an expert witness in some 900 chiropractic cases in the United States, Canada and Puerto Rico. “I’ve known of seven or eight people who died right on the table or shortly thereafter,” he adds. Kristi Alaine Bedenbaugh, 24, of Little Mountain, South Carolina, died in 1993 three days after a cervical manipulation for a sinus headache and a few months before her wedding. In 1998 in Saskatoon, Saskatchewan, 20-year-old restaurant supervisor Laurie Jean Mathiason fell into a coma on her chiropractor’s table minutes after a neck manipulation she received for a tailbone injury; she was dead three days later.

“The twist was so violent that it tore her artery clear through,” says her mother, Sharon Mathiason. “In our wildest dreams, our family had never imagined that a perfectly healthy kid in the prime of her life could have a stroke. But at the hospital, we were bombarded with doctors coming into the waiting room and saying, ‘Don’t you know that (if you go to the chiropractor), never let them touch you above the shoulders?’ I have made it my life’s campaign to warn people of the risks of chiropractic neck adjustment.”

Risks vs. benefits
The stories are frightening. But the actual risk for injury remains a topic of fierce debate. Estimates vary wildly as to how many neck manipulations will lead to a stroke — numbers from 1 in 5.8 million treatments (from an analysis of data from the Canadian Chiropractic Protective Association, a chiropractic malpractice insurer in Toronto) to 1 in 400,000, according to a study published in a 1996 issue of the Journal of Manipulative and Physiological Therapeutics. A 2003 survey of French doctors by the Hospitals of the University of Strasbourg, France, found that the incidence of post-manipulation vascular injuries was 30 times higher than had been published in medical journals. One reason the numbers are so varied may be that there is no formal system for reporting complications from chiropractic manipulation.

Chiropractors and the organizations that represent them say the dangers of manipulating the neck have been overplayed. In all but a handful of states, no law or written ethical guideline requires them to alert patients about the possibilities of damage, and most of them don’t. “A stroke following a manipulation is phenomenally rare,” Lauretti says. “We want to give information to patients to empower them, but at what point does that information become meaningless? With this issue, we are approaching that point.”

Statistically speaking, taking aspirin or another nonsteroidal anti-inflammatory drug for pain is potentially far more toxic than getting one’s neck cracked; NSAIDs account for about 7,500 deaths per year, according to researchers from Stanford University in California. The difference is that aspirin is a scientifically proven pain reliever, and neck manipulation is not, says Brad Stewart, M.D., a neurologist in Edmonton, Alberta, with a special interest in chiropractic stroke.

“The expectation of benefit is almost negligible. The risk, though small, is very real,” says Dr. Stewart, one of whose patients had part of her brain removed after a cervical manipulation mangled both of her vertebral arteries. “You can’t predict who this will happen to, and for that reason alone, it just shouldn’t be done.”

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