Stroke, Arterial Dissection, and Neck Manipulations - Essay Example

Tuesday, February 14, Lilibeth Stroke, Arterial Dissection and Neck Manipulations: A summary of the evidence. Order # 170280 Stroke, Arterial Dissection and Neck Manipulations Spinal manipulative therapy is the correction and fine-tuning of the spine using twisting, pulling or pushing movements. These movements can lighten up, relax, loosen up or reposition the spinal bones and joint structures that cause pain (WebMD medical reference from Healthwise, 2006). It is typified by the use of a short or long lever high-velocity thrust directed to one or more of the joints of the cervical spine. When no- velocity thrust is used then it is called mobilization (Hurwitz et al., 1996). Cervical spinal manipulation, or neck manipulation, is commonly used as a treatment for low back pain, back ache, neck pain, or headache; with a number of 18 to 38 million treatments performed yearly by US chiropractors (Malone, 2002). The growing number of visits to the chiropractor, with the goal of diminishing or eliminating headaches and migraines is alarming; especially taking into account the tremendous risks that involves the procedure. Numerous reasons are behind these numbers, but mainly the ignorance of the public about the procedure as well as the misinformation of the practitioner about the true cause that generates the pain and the lack of following up at the patient condition after each treatment session. Considering Canada, with over 4500 chiropractors, the probability that a chiropractor will be made alerted of arterial dissection following neck manipulation is only 1: 8.06 million office visits, and the equivalent of 1: 5.85 million cervical manipulations (Haldeman et al., 2002). Efficacy of Spinal Manipulation Although the complication rate of cervical manipulation is small, according to Hurwitz et al. (1997), little is known about its efficacy for neck pain and headache. In addition, it is also ambiguous if cervical manipulation treatment produces any long term positive changes in these conditions (Astin and Ernst, 2002). Simultaneously, Bargman (2005) also pointed out the possibility for undesirable outcomes after spinal manipulation, considering the risk of permanent injury or deficit, psychological trauma, quadriplegia and or death (Cooke et al., 2005; Hurwitz et al., 1996; WebMD medical reference from Healthwise, 2006). Ernst and Canter (2006) suggested the minimal success of spinal manipulation on the case of acute or chronic back pain, arguable in the case of headache, and missing for any other indications. However, Bronfort et al. (2006) emphasized the lack of analyzed data for this statement, especially considering that their colleges did not reference a systematic review of comparison with other treatments. To argue about its efficacy is even more complicated when taking into account that spinal manipulation and mobilization are terms used for a variety of techniques, making it too complicated to tell the difference about the type, the location and the duration of the treatment under care (Hurwitz et al., 1996). Precautions when having a Spinal Manipulation When the patient chooses spinal manipulation treatment, some precautions are necessary in order to avoid future complications. The safety measures include the willing of the practitioner to synchronize the treatment with other health physicians if requested and to organize the appointment in the faster possible way. It is also highly advisable to expect a thorough examination before treatment. The chiropractor should provide an adequate amount of information and to advise some home exercises to the patient (as postures), diets (when overweight contributes to the back pain), to diagnose musculoskeletal problems with physical examination and interview the patient about all the possible causes that originate the problem, by avoiding as much as possible the use of X-rays. Unnecessary X-rays give gratuitous amount of radiation levels. The literature advise avoiding unnecessary practices as the use of joint manipulation to treat conditions such as respiratory and ear infections, skin problems, eye conditions, and learning disabilities; to avoid numerous sessions of manipulative therapy (number of treatments and total time per session); to avoid the use of additional and supplemental products such as herbal medicines, holistic products and yoga, if not recommended by a professional (Barret, 2002; WebMD medical reference from Healthwise, 2006). Barret (2002) pointed out the need for being away from chiropractors that recommend biological terrain assessment (a computerized analysis of urine, blood, and saliva with the purpose to advise values of vitamin and mineral supplements, homeopathic products and/or herbs), contact reflex analysis, contour analysis (a photographic technique that highlights body contours), hair analysis, herbal crystallization analysis, live blood cell analysis or hemaview, iridology, acupuncture, allergy tests, cytotoxic testing, magnetic or bio-magnetic therapy, electrodermal testing, pendulum divination, reflexology, and functional intracellular analysis among numerous other tests. The practitioner or therapist should have a great data of the problem by interviewing the patient, and only use general and common techniques, such as heat, slow tender and moderate manual technique, cryotherapy, ultra sound, passive stretching relaxation, transcutaneous electrical nerve stimulation (Hurwitz et al., 1996; WebMD medical reference from Healthwise, 2006). Complications to Consider After Cervical Spinal Manipulation Malone et al. (2002) brought together the work of numerous colleges by listing more than a few complications after cervical spinal manipulation, and some of them are the following ones: Vascular injury and strokes syndromes Vascular injury, hearing loss, locked-in syndrome, vertebrobasilar distribution infarction, thalamic infarction, dissecting aneurysm of the vertebral artery, dissecting hematoma of the internal carotid artery, visual field loss. Structural lesions Intradural herniated cervical disc, lumbar disc rupture, rupture of intervertebral disc, odontoid fracture, atlantoaxial injury. Neural injury Cerebellar & brainstem trauma, diaphragmatic paralysis, cauda equine syndrome, quadriplegia (due to cervical spine manipulation therapy) in cases of spinal cord astrocytoma, myelopathy, radiculopathy. Other injuries Tracheal rupture (post-tracheotomy), cervical epidural hematoma. Vascular Injury and Strokes Syndromes Related with vascular injury and strokes syndromes, Norris et al. (2000) mentioned the tremendous vulnerability to torsion injury of the vertebral artery, because it may twist and turn around the atlas to enter the skull. The lining of the artery bleeds and forms a blood clot and a clot stroke occurs when a blood clot or coagulate obstructs blood flow to a portion of the brain (Aronson, 2005). The sudden disruption of blood flow to the brain caused by a blockage of bleeding is known as stroke. This coagulate can easily go into the brain, and the affected areas can become damaged within minutes. Thrombosis formed over this vascular injury may finally cause a fatal stroke (Cooke et al., 2005; DeNoon, 2002). Neck Manipulations Neck manipulations are safer when the rotation does not go farther than 50 degrees. If rotation is not appropriate or advisable, few special techniques can be helpful. In some cases, by having the patient in a face down position, the manipulative traction can be applied, or there can be thumb contact with specific spinal segments (Homola, 1999). However, considering the numerous risks after a neck manipulation session, some concerns and strong warnings should be reminded to the chiropractors as well as to the public. The following are some organizations focused on giving straight information to the public as well as help, with the hope to prevent any sort of injury and death after a neck manipulation treatment has been done. Families against abusive chiropractic treatments (FAACT) Families against abusive chiropractic treatments (FAACT) is a newly Canadian organization which goal is to change Canadian Health regulations against neck manipulation treatments. Its founder is Michael de Champlain of Vancouver. He started this organization after the very unfortunate procedure practiced to his wife of 44 years old, some years ago. She experienced a dissected vertebral artery as a consequence of neck manipulation by a chiropractor. Till today and as an outcome of this chiropractic therapy she struggles with paralysis and blindness in the right eye, plus all the emotional and psychological traumas left. Any inquiries or data about any reported case related with neck manipulations can be addressed to FAACT, at Michael@FAACT.com (Families against abusive chiropractic treatments, 2004). Neck Manipulations 911 Manual therapy of the spinal column is a reliable procedure by treatment of certain problems of the back ache, however, as many other therapies, there are certain risks that can come up. If this is the case, Neck911USA.com is an international organization that makes available consultations related to neck manipulations. This association works with volunteer members, who are equally concerned about neck problems created from chiropractors as well as other physicians or medical doctors. Any question or concern can be directed to info@Neck911USA.com , and all information is confidential (Neck911USA.com, 2005). Canadian neurologist warn against neck manipulation A group of 62 neurologists issued a strong alert in opposition to neck manipulation to the Canadian public, in 2002. They based their public warn in the literature that over the last 50 years had published numerous cases of stroke (especially in individuals under 45 years old) and death, after receiving neck manipulation treatment. The warning goes straight to the chiropractors, urging them to be extremely conscious about the possible risks of a bad neck manipulation. They insist that chiropractors should make conscious the patients about all the serious neurological complications that an upper neck manipulation session can bring, and urge them to make a fast referral to a neurologist if the patient shows any signs of stroke after the therapy. Some of the signs that should be recognized as an alert for future complications are sudden neck pain, visual disturbances, dizziness, poor coordination, numbness on one side of the body, and nausea. They express concern that in a routine autopsy the vertebral arteries in the neck should be thoroughly examined, as they are most often damaged after a neck manipulation procedure. Most especially if only three months have passed after a visit to the chiropractor for the suspicious stroke incident that causes the death. They urge all of the principal ministries of health for an immediate prohibition of all spinal manipulations of toddler and children. The main reason is that chiropractors advise to the parents to take the babies and children for a cervical manipulation if colic, inner ear infections, and bedwetting among other illnesses. However, paralysis and sudden death have been reported after these sessions (Stewart, 2002). Final Thoughts It is extraordinarily important to be aware of the benefits as well as the risks of having a manipulative neck therapy. There are not enough ways to prevent serious damage or fatalities if having a bad procedure. The public should be extensively informed about the techniques, benefits and risks of the procedure. The information should be given trough the chiropractors, as well as from the health authorities. The public should be conscious of having the interest of being informed, and the follow up with a neurologist if having the slightest doubt about the possibility of an up coming stroke. REFERENCES ARONSON, M H. 2005. Understanding the stroke-the basics. Copyright 2005 WebMD, Inc. All rights reserved. Reviewed by Michael J. Aronson, MD on July 01, 2005. Retrieved 14 May 2007. In: http://www.webmd.com/stroke/understanding/stroke/basics ASTIN, J A., ERNST, E. 2002. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalalgia 22 (8): 617-623. doi:10.1046/j.1468- 2982.2002.00423.x Blackwell Synergy is a Blackwell Publishing, Inc. Registered Trademark. Partner of CrossRef, COUNTER, AGORA, HINARI and OARE. Retrieved 14 May 2007. In: http://www.blackwell-synergy.com/doi/abs/10.1046/j.1468- 2982.2002.00423.x BARGMAN, A. 2005. Stroke due to cervical manipulation. Dynamic chiropractic. February 12, 2005, 23, issue 04. All rights reserved, Dynamics Chiropractic, 2007. Date last modified may 11, 2007. Retrieved 14 May 2007. In: http://www.chiroweb.com/archives/23/04/18.html BARRET, S. 2000. Tips on choosing a chiropractor . Revised 13 October 2000. Retrieved 15 May 2007. In: http://www.quackwatch.org/01QuackeryRelatedTopics/chirochoose.html BARRET, S. 2002. Biological terrain assessment is non sense. Revised 9 April 2002. Retrieved 15 May 2007. In: http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/bioter.html BRONFORT, G., HAAS, M., MOHER, D., BOUTER, R., VAN TULDER, M., TRIANO, J., ASSENDELFT, W JJ., EVANS, R., DAGENAIS, S., and Anthony ROSNER. 2006. Review conclusions by Ernst and Carter regarding spinal manipulation refuted. Chiropractic and Osteopathy. 2006 (14): 14. doi:10.1186/1746-1340-14-14. Retrieved 14 May 2007. In: http://www.chiroandosteo.com/content/14/1/14 COOKE, K V., FACKLER, A., ARISS, K M., BURGESS, P. 2005. Stroke. Copyright 2005-2007 WebMD, Inc. All rights reserved. Last updated 27 May 2005. Retrieved 15 May 2007. In: http://www.webmd.com/hw-popup/stroke-7439 DeNOON, D. J. 2002. Strokes linked to chiropractic treatment. WebMD Medical News. Copyright 2005-2007 WebMD, Inc. All rights reserved. Retrieved 14 May 2007. In: http://www.webmed.com/stroke/mews/200020208/strokes-linked-to- chiropractic-treatment ERNST, E., CANTER P H. 2006. A systematic review of systematic reviews of spinal manipulation. Journal of the royal society of medicine. 2006 (99): 192-196. Retrieved 15 May 2007. In: http://www.jrsm.org/cgi/reprint/99/4/192 Families against abusive chiropractic treatments. 2004. Copyright 2004- FAACT. Retrieved 15 May 2007. In: http://www.faact.com./contact.htm HALDEMAN, S., CAREY, P., TOWNSED, M., PAPADOPOULOS, C. 2002. Clinical perceptions of the risk of vertebral artery dissection after cervical manipulation: The effect of referral bias. Spinal Journal. 2002 Sept; 2 (5): 334-342. Copyright The Chiropractic resource organizations. All rights reserved. Retrieved 14 May 2007. In: http://www.chiro.org/ChiroZine/Abtracts/Clinical_perceptions.shtml HOMOLA, S. 1999. What a rational chiropractor can do for you. May 1999. Retrieved 15 May 2007. In: http://www.chirobase.org/07Strategy/goodchiro.html HURWITZ, E.L., AKER, P.D., ADAMS, A.H., MEEKER, W.C., SHEKELLE, P.J. 1996. Manipulation and mobilization of the cervical spine: A systematic review of the literature. Spine 1996 : 21 (15): 1746- 1760. Copyright 2007 The Chiropractic Resource Organization. All rights reserved. Retrieved 14 May 2007. In: http://.www.chiro.org/LINKS/ABSTRACTS/Manipulation_and_Mobilizat ion.shtml HURWITZ, E.L., AKERr, P.D., ADAMS, A.H., MEEKER, W.C., SHEKELLE, P.J. 1997. Manipulation and mobilization of the cervical spine: A systematic review of the literature. Spine 1997: 22 (14): 1776-7. PMID: 8855459 PubMed - indexed for MEDLINE] Retrieved 14 May 2007. In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgicmd=Retrieve&db=PubMed_list_ uids=8855459&Adopt=Abstract MALONE D. G., M.D., BALDWIN, N. G., M.D., TOMECEK F. J., M.D., BOXELL, C. M., M.D., GAEDE, S. E., M.D., COVINGTON, C. G., M.D., KUGLER, K. K., M.D. 2002. Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice. Neurosurg Focus :13(6). Copyright 2002 American Association of Neurological Surgeons. Posted 24 January 2004. Retrieved 13 May 2007. In: http:///www.medscape.com/viewarticle/446744_print Neck911USA.com. 2005. Copyright 2005Neck911USA. Retrieved 15 May 2007. In: http://www.Neck911USA.com/reso.htm NORRIS, J.W., BELETSKY, V., NADAREISHVILI, Z G., and of the behalf of the Canadian Stroke Consortium. 2000. Sudden neck movement and cervical artery dissection. Canadian Medical Association Journal, 2000: 163 (1). Copyright 2000 Canadian Medical Association or its licensors. Retrieved 13 May 2007. In:http://www.cmaj.cacgi/content/full/163/1/38ijkey=8f15fce0a327555af c281c433ca7ac9ed8096023&keytype2=tf_ipsecsha STEWART, B. 2002. Canadian neurologists warn against neck manipulation. Updated 13 March 2002. Retrieved 16 May 2007. In: http://www.chirobase.org/15News/neurol.html WebMD Medical Advice from HealthWise. 2006. Back pain health center. Copyright 1995-2007 WebMD, Inc. All rights reserved. Last updated 15 February 2006. Retrieved 15 May 2007. In: http://www.webmd.com/back-pain/tc/low-back-pain-topic-overview Read More