Chiropractic Cervical Manipulation and Arterial Dissection: Epidemiology, Mechanisms, And Forensic Implications

Cervical spinal manipulation (CSM) is widely used to treat neck pain and headache but remains controversial because of reported associations with vertebral and carotid artery dissection and stroke. Evidence includes case reports and series suggesting possible causal links, in contrast to large epidemiologic studies that generally show an extremely low absolute risk and difficulty distinguishing causation from care-seeking for prodromal dissection symptoms (Cassidy et al., 2008; Whedon, Song, Mackenzie, et al., 2015; Xia et al., 2021). This paper reviews epidemiology, mechanisms, standards of chiropractic care, and medico-legal considerations, incorporating studies that both support and question a causal relationship between CSM and cervical artery dissection.