What is cervical artery dissection and how common is it, in chiropractic treatments?

Ask the Professor, with SCU’s Dr. Jim Whedon 

James Whedon DC, MS, Professor & Director of Health Services Research, and colleagues were recently published in BMC Geriatrics, an open access journal publishing original peer-reviewed research articles in all aspects of the health and healthcare of older people, including the effects of healthcare systems and policies. Their article, “Association between cervical artery dissection and spinal manipulative therapy –a medicare claims analysis,” evaluated the association between cervical spinal manipulation and cervical artery dissection in older Medicare beneficiaries, in the United States.

From 2007-2015, researchers analyzed claims data for both hospitalized patients, as well as outpatient encounters, following them for at least two consecutive years. Their studies are ongoing, and the research team has recently completed a similar study focused on a population of younger adults in the U.S., and expect to publish the results, soon.

Dr. Whedon answers several questions about cervical artery dissection, how common it is, who may be at risk, how to prevent it, and more.

How common is it to see dissected arteries – both in general; and specifically linked to chiropractic treatments?

Our research focused on dissection of the cervical arteries in the neck that supply blood to the brain. Cervical artery dissection is very rare. There are two pairs of cervical arteries: the vertebral arteries and the internal carotid arteries. The annual incidence of internal carotid artery dissection is approximately 1.72 per 100,000 persons persons; for vertebral artery dissection the incidence rate is less than 1 per 100,000 persons.

Are certain populations more susceptible to having arteries become disjointed – both in general, and during chiropractic visits?

Rarely, trauma to the head or neck may cause cervical artery dissection. Spontaneous dissection is also rare; people with connective tissue disease such as Ehlers Danlos-syndromes (a group of inherited connective tissue disorders caused by abnormalities in the structure, production, and/or processing of collagen) or Marfan’s syndrome (a condition affecting a protein in the body that helps build healthy connective tissues) may be at higher risk, and possibly patients with underlying arterial disease. Patients with neck pain who see a chiropractor are at no greater risk of dissection than those who see a medical physician.

When this happens, what can be done, and what is the prognosis for patients?

Arterial dissection is most often treated with blood thinner medication. Medical evaluation of a patient with dissection will determine their prognosis, which varies by each individual’s underlying health status.

How can chiropractors and patients prevent this from happening?

Because cervical artery dissection is very uncommon and the etiology (the cause, or causes) of spontaneous dissection remains uncertain, there is no specific prevention strategy for patients, other than making diet, exercise and lifestyle choices that support good general health. Doctors of Chiropractic are well prepared to counsel patients about the risk of cervical artery dissection and engage with patients in shared healthcare decision-making.