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Risk Factors and Precipitating Neck Movements
Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal
Manipulation.
Spine 1999 Apr
15;24(8):785-94
Haldeman S, Kohlbeck FJ, McGregor
M.
Department of Neurology, University of California, Irvine, USA.
STUDY DESIGN: Potential precipitating events and risk factors for vertebrobasilar
artery dissection were reviewed in an analysis of the English language literature
published before 1993.
OBJECTIVES: To assess the literature pertaining to precipitating neck movements
and risk factors for vertebrobasilar artery dissection in an attempt to determine
whether the incidence of these complications can be minimized.
SUMMARY OF BACKGROUND DATA: Vertebrobasilar artery dissection and occlusion
leading to brain stem and cerebellar ischemia and infarction are rare but often
devastating complications of cervical, manipulation and neck trauma. Although
various investigators have suggested potential risk factors and precipitating
events, the basis for these suggestions remains unclear.
METHODS: A detailed search of the literature using three computerized bibliographic
databases was performed to identify English language articles from 1966 to
1993. Literature before 1966 was identified through a hand search of Index
Medicus. References of articles obtained by database search were reviewed to
identify additional relevant articles. Data presented in all articles meeting
the inclusion criteria were summarized.
RESULTS: The 367 case reports included in this study describe 160 cases of
spontaneous onset, 115 cases of onset after spinal manipulation, 58 cases associated
with trivial trauma, and 37 cases caused by major trauma (3 cases were classified
in two categories). The nature of the precipitating trauma, neck movement,
or type of manipulation that was performed was poorly defined in the literature,
and it was not possible to identify a specific neck movement or trauma that
would be considered the offending activity in the majority of cases. There
were 208 (57%) men and 158 (43%) women (gender data not reported in one case)
with an average age of 39.3 +/- 12.9 years. There was an overall prevalence
of 13.4% hypertension, 6.5% migraines, 18% use of oral contraception (percent
of female patients), and 4.9% smoking. In only isolated cases was specific
vascular disease such as fibromuscular hyperplasia noted.
CONCLUSIONS: The literature does not assist in the identification of the offending
mechanical trauma, neck movement, or type of manipulation precipitating vertebrobasilar
artery dissection or the identification of the patient at risk. Thus, given
the current status of the literature, it is impossible to advise patients or
physicians about how to avoid vertebrobasilar artery dissection when considering
cervical manipulation or about specific sports or exercises that result in
neck movement or trauma.
Publication Types:
Review
Review Literature
PMID: 10222530 [PubMed - indexed for MEDLINE]
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