This case involves a young female patient in North Dakota who sought chiropractic treatment for chronic back pain, which she had endured for several months. She received a chiropractic spinal manipulation and adjustment the day before the incident in question. The following day the patient presented to the emergency room after experiencing a loss of sensation on her right side, and was investigated for stroke. Despite immediate treatment with tPA, the patient’s condition continued to deteriorate, and she was left with severe and permanent disabilities. It was alleged that the woman’s stroke was caused by the chiropractic manipulation.
Question(s) For Expert Witness
- 1. Do you routinely perform neck manipulations?
- 2. Should patients be warned about the risks of neck manipulation?
Expert Witness Response E-009668
I currently teach full-time at a major chiropractic college where I teach students how to apply safe and effective neck manipulation, and I routinely perform neck manipulation on colleagues and students. The issue is complicated. Based on current evidence, the causal relationship between neck manipulation and stroke is still controversial. In the absence of specific risk factors, I do not believe the evidence supports the necessity of routinely warning patients of the risk of stroke from neck manipulation. However, if a patient presents with specific risk factors informed consent is necessary. This means a chiropractor must perform a thorough history and examination to rule out these risk factors. Many of these cases hinge on the thoroughness and appropriateness of the chiropractor’s pre-treatment evaluation. In this case, it is unclear whether this patient had specific neck-related complaints that would indicate the neck manipulation was appropriate. In the absence of any significant neck complaints, neck manipulation would not be appropriate. Since any benefit of neck manipulation would be unclear, I believe specific informed consent discussing possible risks would be required.