This case involves a 27-year-old female patient with a past medical history of hypertension. The patient presented to a chiropractor for adjustment and neck manipulation. The patient had seen this particular chiropractor in the past and the chiropractor had successfully performed 2 previous manipulations on the patient. Several hours after the manipulation, the patient’s husband found her collapsed in the bathroom with an altered mental state. She was admitted to the hospital and diagnosed with an acute stroke secondary to carotid artery dissection. It was alleged that the chiropractor was negligent in performing the neck manipulation. An expert chiropractor was sought to review the medical records and opine on the standard of care.
Question(s) For Expert Witness
- 1. How often do you perform neck manipulations?
- 2. What measures should be taken to prevent injury to the carotid arteries?
Expert Witness Response E-009668
I currently teach neck manipulation full-time to students at a chiropractic college and I perform them at least several times per week. Before joining the college faculty in 2005, I was in private chiropractic practice full-time for 15 years, during which time I performed neck manipulations multiple times per day. For anatomical reasons, it is highly unlikely that a neck manipulation can cause a carotid artery dissection. In my opinion, this case as described hinges on whether or not the chiropractor involved performed a thorough history and exam on this patient prior to treatment that could have enabled him or her to recognize red flags of an evolving dissection. I have reviewed numerous cases of alleged vertebral artery dissections following chiropractic manipulation as a consultant for both plaintiffs and defendants.