Spinal manipulative therapy and cervical artery dissection: A retrospective comparison with spontaneous, traumatic, and iatrogenic etiologies at a single academic medical center

Abstract

OBJECTIVE\nCervical artery dissection (CAD) has been associated with spinal manipulative therapy (SMT). Although uncommonly reported, SMT-associated CADs hold devastating neurological consequences, warranting further exploration. We endeavored to investigate this association through the comparison of all CAD etiologies at a single academic medical center.\n\n\nMETHODS\nA retrospective chart review was conducted of patients diagnosed with CAD or transferred to our institution for primary management of CAD during the 10-year period from 2010 to 2020 (n\xa0=\xa0578). Patients were divided into SMT-associated (within 1 month of presentation), spontaneous, traumatic, and iatrogenic cohorts.\n\n\nRESULTS\nSMT-associated dissections represented 23/578 (4%) of all dissections and 5.9% of vertebral artery dissections specifically. These patients were generally younger than those in the spontaneous (p\xa0=\xa0.004) and iatrogenic groups (p\xa0<\xa0.001), and more often non-smokers or former smokers compared to the spontaneous (p\xa0=\xa0.009), traumatic (p\xa0=\xa0.001), and iatrogenic (p\xa0=\xa0.008) groups. Additionally, the SMT group had a higher mean low-density lipoprotein (LDL) than the spontaneous (p\xa0=\xa0.009) and traumatic (p\xa0=\xa0.003) types. SMT-associated CADs were more often vertebral and bilateral, compared to the spontaneous (p\xa0=\xa0.003; p\xa0<\xa0.001), traumatic (p\xa0=\xa0.047; p\xa0=\xa0.004), and iatrogenic (p\xa0=\xa0.002; p\xa0=\xa0.002) groups. Outcomes including infarct (p\xa0=\xa0.112), medical treatment (p\xa0=\xa0.523), intervention (p\xa0=\xa0.47), and length of stay (p\xa0=\xa0.512) were similar between the SMT and spontaneous groups.\n\n\nCONCLUSIONS\nIn this unique study comparing SMT-associated CADs with other dissection etiologies, SMT-associated CADs were uncommon and not associated with worse clinical outcomes. However, SMT-associated CADs were more likely to be bilateral and affected the vertebral arteries in young, non-smoking patients with high LDL.