Chiropractic + Naturopathic Doctor

Research Review Corner: October 2010

By Shawn Thistle BKin (Hons) DC CSCS   

Features Research

Study Title: Late sequelae of whiplash injury with dissection of cervical arteries
Author(s): Hauser V et al.
Publication Information: European Neurology 2010; 64: 214-218

Study Title: Late sequelae of whiplash injury with dissection of cervical arteries
Author(s): Hauser V et al.
Publication Information: European Neurology 2010; 64: 214-218

Background Information
All chiropractors are familiar with the potential association of vertebral artery dissection (VAD) and upper cervical spinal manipulation. We know it is extremely rare, and that it can be caused by everyday activities and movements. We discuss it prudently with our patients during the informed consent process and we are constantly looking for warning signs of this condition. My intent in reviewing this particular paper is not to review the literature on vertebral artery dissection. That being said – a brief review of some simple concepts is in order. Arterial dissections are normally categorized as post-traumatic (about one-third of cases) or spontaneous/non-traumatic (about two-thirds of cases). They involve a tear forming in the tunica intima of an artery that results in blood accumulating in the space between the intima and media. In time this can lead to complete occlusion of the vessel which is often followed by recanalization after several months. During this process thrombosis/embolism can occur. Depending on the artery involved, neurological deficits can arise.

Advertisement

This retrospective case analysis investigated the incidence of posttraumatic cervical artery dissections (CAD), including those involving the vertebral artery, in patients who had sustained a whiplash injury in a motor vehicle collision. The results certainly warrant further study and should raise our vigilance even further in patients who have sustained such injuries.

Conclusions and Practical Applications
This study revealed a higher incidence of CAD in subjects who had sustained a neck injury in a motor vehicle collision, compared to existing population data. Indeed, the retrospective study design cannot establish cause and effect for this association, but it certainly should raise awareness of this potential association, as well as practitioner vigilance to screen and monitor our whiplash patients for the development of CAD (even months after the collision). Subsequent research on larger patient samples, utilizing a prospective cohort approach would help clarify this issue. Until then, prudent clinicians should be aware that:

those who have suffered a whiplash injury may be at higher risk of developing CAD
CAD is not always recognized immediately after an accident, and may remain asymptomatic for a number of months (presumably even during treatment)

There was no mention or investigation into whether the eight cases of CAD had seen a chiropractor.

Stay tuned for further research on this important topic.


For this review in full, including a summary of the study, visit www.cndoctor.ca


Print this page

Advertisement

Stories continue below