Misrepresentation of Chiropractic and the Unfounded Link to Cervical Artery Dissection

Written by: James Demetrious, DC, DABCO

There Is No Proven Causal Relationship Between Chiropractic Spinal Manipulation and Cervical Artery Dissection (CAD)

Yet another recent article presents a compelling narrative. It is essential to distinguish between emotional anecdotes and scientific evidence, particularly when discussing public health and chiropractic care.

Case Reports and News Articles Are Not Evidence of Causation

  • Too often:
    • No timeline of symptom progression is provided.
    • No neurological exam findings are presented.
    • No differential diagnosis is discussed.
    • No discussion regarding the specific care provided.
    • No past history was provided related to heritable or acquired pre-existing conditions, such as blood pressure irregularities, connective tissue disorders, fluoroquinolone use, or vascular anomalies, or prior fluoroquinolone use are reported.

Sensational Journalism Undermines Scientific Understanding

Such articles are designed for virality. They capitalize on dramatic personal experiences and legitimate emotional distress to trigger fear-based responses from the public. However, they often omit the broader scientific context.

Chiropractic Spinal Manipulation Is Widely Recognized as Safe

It is a cornerstone of conservative musculoskeletal care. It is recognized by leading health organizations, including the World Health Organization and the American College of Physicians, as an effective treatment option for certain spinal conditions when performed by trained clinicians.

The Incidence of Spontaneous CAD is Estimated from ~2.6-8.93 per 100,000 Person-Years

A recent Mayo Clinic article revealed an increase in the prevalence of CAD in their cohort was due to increased utilization of CTA. While rare, spontaneous CAD do occur in our population and patients should be aware of associated risk factors, symptoms and signs.

Promoting Awareness Should Not Come at the Expense of Truth

Public health discussions should be informed by balanced evidence, not fear. As a public health initiative, PCPs should bear responsibility and disclose to patients and chiropractors pre-existing predispositions, including:

  • A recent article indicated that 50–96% of CADs occur in patients with diagnosed and undiagnosed connective tissue disorders.
  • The causal relationship of fluoroquinolone medications and cervical artery dissections that I discovered and published: https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0193-z
  • Signs and symptoms of developing CAD.

Summary

CAD is a serious medical condition, and the best available evidence strongly suggests that chiropractic care is NOT a causal factor. Major complications from cervical manipulation are exceedingly rare.

Rather than focus on anecdotal claims that are unsubstantiated, it would serve the public well to disseminate information about the heritable and acquired predispositions of cervical artery dissection.

All patients should be aware of the signs and symptoms of developing CAD and stroke.

To improve the detection of developing cervical artery dissections and stroke, register for our 10-CE hour, Cervical Artery Dissection – DDX Certification coursework.

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is a distinguished board-certified chiropractic orthopedist, educator, author, and editor. 

Disclosure

The information provided in this article and all PostGradDC coursework should not be considered standards of care. We offer this information for educational purposes only. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding medical conditions or treatment. Seek the opinion of your legal representative.

© 2025 – James Demetrious, DC, DABCO. Open Access. Unrestricted use, distribution, and reproduction are allowed in any medium, provided you give appropriate credit by citing the original author and source: Demetrious J. PostGradDC. Misrepresentation of Chiropractic and the Unfounded Link to Cervical Artery Dissection. PostGradDC.com; 2025.