CASE REPORT IS CERVICAL SPINAL MANIPULATION DANGEROUS? Peter B. Licht, MD, PhD, a Henrik W. Christensen, DC, MD, b and Poul F. Høilund-Carlsen, MD, DMSc c ABSTRACT Objective: Concern about cerebrovascular accidents after cervical manipulation is common. We report a case of cerebrovascular infarction without sequelae. Clinical Features: A 39-year-old man with nonspecific neck pain was treated by his general practioner with cervical manipulation. Intervention and Outcome: This immediately elicited severe headache and neurologic symptoms that disappeared completely within 3 months despite permanent signs of a complete left-sided cerebellar infarction on computed tomography and magnetic resonance imaging. At 7-year follow-up the patient was fully employed, and repeated magnetic resonance imaging still showed infarction of the left cerebellar hemisphere. However, the patient remained completely free of neurologic symptoms, and color duplex ultrasonography showed normal cervical vessels, including patent vertebral arteries. Conclusion: It appears that the risk of cerebrovascular accidents after cervical manipulation is low, considering the enormous number of treatments given each year, and very much lower than the risk of serious complications associated with generally accepted surgery. Provided there is a solid indication for cervical manipulation, we believe that the risk involved is acceptably low and that the fear of serious complications is greatly exaggerated. (J Manipulative Physiol Ther 2003;26:48-52) Key Indexing Terms: Chiropractic Manipulation; Cervical Spine; Stroke I NTRODUCTION S pinal manipulative therapy (SMT) is used to relieve symptoms from biomechanical dysfunction of the spine. It is commonly performed by chiropractors, and its use is increasing. More than 250 million treatments are delivered each year in the United States alone. 1 Approx- imately one third of the manipulations are applied to the cervical spine. Serious complications are reported rarely, the most feared being cerebrovascular accidents (CVA) after cervical manipulation. We report the case of a patient who had a CVA after cervical manipulation and is now completely asymptomatic, despite a large cerebellar infarc- tion still visible on magnetic resonance (MR) scan at fol- low-up. CASE REPORT A 39-year-old previously healthy male ambulance driver had influenza-like symptoms, with soreness and discomfort in the muscles of the shoulder and neck, cough, and a fever up to 39°C 2 weeks before hospitalization. One week before admission these symptoms had disappeared, but he now complained of nonspecific pain in the left side of his neck, which he attributed to an uncomfortable working position in front of his computer. His friend, who was a medical doctor, tried to relieve his pain at home by gentle mobilization of the neck, but this treatment was stopped because the patient experienced mild nausea and increased pain projecting to the left ear. The following day he consulted his general practitioner who, despite information about his response to a MD, Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital, Odense, Denmark. b Research Fellow, Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark. c Professor, Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital, Odense, Denmark. Submit reprint requests to: Peter Licht, MD, PhD, Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital, DK-5000 Denmark (e-mail: peter.licht@sks.aaa.dk). Paper submitted September 27, 2001; in revised form October 30, 2001. Copyright © 2003 by JMPT. 0161-4754/2003/$30.00 + 0 doi:10.1067/mmt.2003.42 48