Dr. Oz, chiropractic and the concerns raised about the safety of cervical manipulation. The truth about chiropractic safety. Recently, we have read about a model, Katie May who after a modeling session where her neck was held in a certain position for a long term began to experience neck pain. She eventually was treated by a chiropractor in the interim and a few days later died from an arterial dissection. The press through provocative headlines seemed to link the chiropractor to this event, and while it made great headlines, the truth is that the dissection was already underway by the time she visited her chiropractor, who was unaware that this may have been underway already. Dr. Oz recently did a program that looked at the safety of chiropractic. Studies are showing that there is no proven link that cervical manipulation causes strokes. Three known studies include http://www.cureus.com/articles/4155-systematic-review-and-meta-analysis-of-chiropractic-care-and-cervical-artery-dissection-no-evidence-for-causation http://journals.lww.com/spinejournal/Abstract/2008/02151/Risk_of_Vertebrobasilar_Stroke_and_Chiropractic.19.aspx http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0063-x What came out of Dr. Oz's show who is a very large proponent of chiropractic is The family of Ms. May are naturally upset about the loss of a loved one. They are entitled to their emotional grief, and if they may choose to direct it toward our profession. There is nothing to be gained by engaging them in a discussion while they are in their emotional state. Have the data cited on The Dr. Oz Show from chiropractic education in mind when you speak with patients about these matters: Life University, 25 years, 4.5 million cervical adjustments"”no dissection related issues have been reported Among all 17 chiropractic educational institutions, 20 years, millions of cervical adjustments"”no dissection related issues have been reported The 25-year window at LIFE and the 20-year window across chiropractic education should not imply something happened 26 or 21 years ago, respectively. The data isn"™t available for the period before those dates. Patients will want to chat about the 5 Ds, 3 Ns and the A Dysphagia, dysarthria, diplopia, drop attacks and nystagmus are important symptoms that, by themselves in the presence of neck pain, strongly suggest referral. Dizziness, nausea, numbness and ataxia are not as strongly associated by themselves with dissection and stroke, but you should look for the development of these symptoms in a constellation as a guide to increasing your index of suspicion. When patients present saying that my neck pain is "œunlike any pain I ever had before in my life" or "œthe most unusual pain I have ever had" or "œthe worst pain I have ever had," THINK about the possibility of a dissection in progress and handle accordingly. Chiropractic care is very safe. When it is viewed in a comparative sense with pharmaceuticals or surgery for similar types of problems, it is remarkably safe. Life has risks. There are fewer risks under chiropractic care than under medical or surgical care. This wasn"™t discussed on The Dr. Oz Show, but it is something you should be aware of: The Coroner"™s Report in the case of Ms. May noted: "œBilateral vertebral artery dissection is a rare complication of neck manipulation in one per 100,000 to one in 2 million manipulations. (South Med J. 2007 Feb; 100(2):201-3)" The literature cited is misquoted as follows: The article states "œSerious complications are infrequent, with a reported incidence between one per 100,000 and one per 2 million manipulations." This does not refer exclusively to vertebral artery complications. This does not refer to bilateral vertebral artery dissection. The literature cited did not identify an arterial dissection-unilateral or bilateral on imaging or during autopsy. The literature cited was the weakest class of evidence, a single case study, and neglected the opportunity to refer to two more recent case-control and case-crossover studies (Cassidy, 2008) and Kosloff (2015). He also chose not to refer to a recent meta-analysis on this subject conducted by neurosurgeons at Penn State Hershey Medical Center (Church, 2016). Bilateral cervical artery dissection is more commonly associated with arteriopathy than with other causes. When you consider more than 100,000 deaths annually in the U.S. from PROPERLY prescribed drugs, it is quite clear that reports such as this are quite unfair, since chiropractors have a clear safety records, and our malpractice rates are among the lowest in the nation for the care our profession delivers. The literature shows the safety of chiropractic cervical manipulation. In our office, we find most neck problems are in fact problems in other parts of the body with the cervical region being the symptom only. Chiropractic care has been proven again and again to be safe, effective and essential care to the general public.