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Eur Neurol. 2009;61(2):112-8. doi: 10.1159/000180314. Epub 2008 Dec 9.

Cerebrovascular complications of neck manipulation.

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  • 1Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.


The safety of spinal manipulation is an issue that demands regular and rigorous assessment, as manipulation of the upper spine has been associated with serious adverse events such as cerebrovascular accidents due to cervical artery dissection. A correlation between stroke and cervical manipulation has been reported with increasing frequency, and each new report seems to reignite debate between neurologists and manual therapists. Specific risk factors for cerebrovascular complications related to spinal manipulation have not been identified yet; for this reason, any patient may be at risk, particularly those below 45 years of age. Patients undergoing spinal manipulative therapy need to consent to the possible risk of stroke or vascular injury from the procedure.

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