Journal article
Cervical Artery Dissection Diagnosed Following Chiropractic Cervical Manipulation: A STOP-CAD Subanalysis
The Neurologist (Baltimore, Md.)
01/20/2026
DOI: 10.1097/NRL.0000000000000656
PMID: 41557514
Abstract
Cervical artery dissection (CeAD) is an important cause of ischemic stroke in young adults. Nearly 100 million annual chiropractic cervical manipulations are performed in the United States. The relationship between manipulation and CeAD remains controversial.
We analyzed patients in the multicenter STOP-CAD registry (n=4023) to identify CeAD cases diagnosed after chiropractic cervical manipulation. Demographics and clinical features were compared between manipulation-associated and nonmanipulation-associated cases using χ2 and t tests. Multivariable logistic regression identified key factors associated with manipulation-related CeAD.
About 1 in 20 CeAD cases in this registry reported antecedent cervical manipulation. In multivariable binary logistic regression, compared with patients without prior manipulation, those with prior manipulation were younger (OR per year 0.98, 95% CI: 0.97-0.99, P=0.014), more often female (OR: 1.64, 95% CI: 1.21-2.23, P=0.001), less often diabetic (OR: 0.24, 95% CI: 0.08-0.78, P=0.018), presented with neck pain (OR: 2.80, 95% CI: 2.08-3.77, P<0.001), and had higher odds of isolated vertebral artery dissection (OR: 2.15, 95% CI: 1.57-2.94, P<0.001). Recurrent ischemic stroke rates were similar between groups.
Given the very high number of manipulations performed annually, the absolute risk of secondary CeAD is extremely low. Manipulation-associated cases have distinct clinical features, occurring more often in younger women with vertebral dissections. Whether manipulation acts as a precipitating trigger or patients with early CeAD symptoms seek manipulation remains unresolved.
Details
- Title: Subtitle
- Cervical Artery Dissection Diagnosed Following Chiropractic Cervical Manipulation: A STOP-CAD Subanalysis
- Creators
- Rozaleen Aleyadeh - Brown UniversityMarialuisa Zedde - Azienda Sanitaria Unità Locale di Reggio EmiliaJoao P Marto - Hospital de Egas MonizNils Henninger - University of Massachusetts Chan Medical SchoolJamil Said - Aga Khan University NairobiJennifer A Frontera - NYU Langone HealthRicha Sharma - Yale New Haven HospitalRonen R Leker - Hadassah Medical CenterThais L Secchi - Hospital Moinhos de VentoFransisca Indraswari - Miriam HospitalAbid Y Quereshi - University Medical CenterLily W Zhou - University of British ColumbiaAlexandre Y Poppe - Université de MontréalHipolito Nzwalo - Department of Internal Medicine, Centro Hospital Universitario do Algarve, FaroVictor C Wall - Centro Medico Nacional Siglo XXIAna C Fonseca - Hospital de Santa MariaPiers Klein - Boston Medical CenterDavid S Liebeskind - University of California, Los AngelesSheila C O Martins - Hospital de Clínicas de Porto AlegreMalik Ghannam - University of IowaVishnu Dantu - Brown UniversityJorge G Ortiz Gracia - University of OklahomaGiovanna De Marco - Ospedale “M. Bufalini” di CesenaEkaterina Bakradze - University of Alabama at BirminghamMary Penckofer - Massachusetts General HospitalAnvesh Balabhadra - Hartford HospitalSetareh S Omran - University of Colorado Anschutz Medical CampusChristopher Chang - Brown UniversityChristopher R Leon Guerrero - Department of Neurology, Atrium Health, Charlotte, NCVarsha Muddasani - Einstein Healthcare NetworkRegina von Rennenberg - Charité - Universitätsmedizin BerlinXiaofan Guo - Loma Linda UniversityCheran Elangovan - University of Tennessee Health Science CenterMohammad AlMajali - University of IowaFaddi S Velez - Ospedale “M. Bufalini” di CesenaReza B Shahripour - University of California San DiegoDaniel M Mandel - University of BridgeportAdeel Zubair - Yale New Haven HospitalMarwa Elnazeir - University of LouisvilleBalaji Krishnaiah - Department of Neurology, University of West Virginia, Bridgeport, WVChristoph Stretz - Brown UniversityShadi Yaghi - Brown UniversityNancy Maalouf - Lebanese American University
- Resource Type
- Journal article
- Publication Details
- The Neurologist (Baltimore, Md.)
- DOI
- 10.1097/NRL.0000000000000656
- PMID
- 41557514
- NLM abbreviation
- Neurologist
- ISSN
- 2331-2637
- eISSN
- 2331-2637
- Publisher
- Wolters Kluwer
- Language
- English
- Electronic publication date
- 01/20/2026
- Academic Unit
- Neurology
- Record Identifier
- 9985130058602771
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