Chiropractic Malpractice / Wrongful Death
Michael S. Wilensky, LLC is one of the few law firms in Georgia that holds accountable the chiropractic community that has downplayed the risk of stroke through cervical manipulation. One of the most common claims we see are allegations of a vertebrobasilar injury caused by chiropractic cervical manipulation. A cervical manipulation is a chiropractic adjustment to the spine located in the neck. Death or injury due to a chiropractic adjustment forms a legal claim when a chiropractor violates the standard of care by not doing a proper history or thorough examination with vascular screening, avoiding rotation and extension during cervical manipulation and / or conducting close monitoring of post treatment progress.
A stroke, arterial dissection or other vascular damage caused by a chiropractic treatment is a tragic, life-altering situation. Vertebrobasilar injuries caused by a chiropractor account for under 10% of the malpractice suits filed each year against chiropractor’s, but they are among the most serious. Vertebrobasilar injuries often result in permanent neurological deficit, psychological trauma, quadriplegia, or death.
For years it was incorrectly thought that the elderly were at a higher risk of stroke due to cervical manipulation. Actually, the demographics that are most at risk of vertebrobasilar injury with cervical manipulation are middle aged men and women in the 30-45 age group. the symptoms to watch for after a cervical manipulation are severe headache, neck pain or cervical muscle spasms. Call 911 if you have any of these symptoms after a cervical manipulation.
The American Heart Association and the American Stroke Association recently concluded:
“Clinical reports suggest that mechanical forces play a role in a considerable number of CDs [cervical dissection], and population controlled studies have found an association of unclear etiology between CMT [cervical manipulative therapy] and VAD [vertebral artery dissection] stroke in young patients. Although the incidence of CD in CMT patients is probably low, and causality difficult to prove, practitioners should both strongly consider the possibility of CD and inform patients of the statistical association between CD and CMT, prior to performing manipulation of the cervical spine.”
It is not that all chiropractic adjustments of the neck will cause severe harm or death. Many chiropractors receive great education, do proper screening procedures and make the public aware of the treatment and risks. However, some, through their literature and studies, have downplayed the risk. Even more shocking, the American Chiropractic Association (ACA) website states that “there is a lack of evidence to prove that cervical adjustments cause stroke.”
Today, chiropractors have more patients than ever before. According to the American Chiropractic Association, approximately 20,000,000 Americans visit chiropractors each year. If we assume those Americans, on average go 5 times per year at which a cervical manipulation is performed, then that is 100,000,000 cervical manipulations every year. With this immense number of cervical manipulations the percentages of injury carry great weight.
In 1983, one study suggested there are two to three serious incidents involving the vertebrobasilar system in one million manipulations. This would mean that currently there are 200 to 300 serious incidents involving the vertebrobasilar system each year. A more recent study in Canada found that the risk of a vertebrobasilar injury from cervical manipulation may be as high as 1.3 incidents per 100,000 cervical manipulations. This would mean that currently there are 1,300 people seriously injured each year through cervical manipulation. An even higher incident rate was found in a March 2001 study, in the New England Journal of Medicine, which estimated that the incidence of vertebral or carotid artery dissections may even be as high as one incident per 20,000 cervical manipulations.
A 2010 study of deaths after spinal manipulation found 26 published cases, and seven unpublished ones, mostly due to a tear, or “dissection of a vertebral artery,” and suggested that many more cases had not been reported. A 2007 survey of adverse effects published in medical journals between 2001 and 2006 found that “spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke.” It noted that “survey data indicated that even serious adverse effects are rarely reported in the medical literature.” A 2013 survey of 43 studies conducted between 2001 and 2011 found 707 incidents of stroke associated with cervical spinal manipulation therapy, but the authors said that understanding such incidents was hampered by inadequate reporting.
Felipe Albuquerque, a neurosurgeon in Phoenix has stated, ““The epidemiology of these injuries is almost impossible to ascertain,” Albuquerque and others wrote in a 2011 study in the journal Neurosurgery. “Studies suggest their incidence to be between 1 in 100,000 and 1 in 6,000,000 manipulations. Given that Americans visit chiropractors more than 250,000,000 times per year and that 30 percent of these visits involve cervical manipulation, the incidence of arterial dissection is likely to be higher than the lowest estimates. A significant number of dissections may go unreported either because they are mild or asymptomatic.”
In February of 2016, Katie May, a well-known model, died. The L.A. County Coroner’s office found the cause of death was an injury during “neck manipulation by chiropractor.” In this specific case, the neck adjustment caused a cervical artery dissection (CD). This occurs when a trauma, like a neck manipulation (aka cervical manipulation), causes a small tear in the layers of artery walls in the neck. A 2014 statement from the American Heart Association states that, “[i]t can result in ischemic stroke if a blood clot forms after a trivial or major trauma in the neck and later causes blockage of a blood vessel in the brain. Cervical artery dissection is an important cause of stroke in young and middle-aged adults.”
There are many high risk categories for cervical manipulation. Please make sure your chiropractor does a proper history prior to any cervical manipulation. And, call 911 if you have severe headache, neck pain or cervical muscle spasms after a cervical manipulation.