Caitlin Jensen’s chiropractor called 911 when she developed alarming symptoms after neck manipulation. She had a heart attack, was pulseless for 10 minutes, and suffered traumatic brain injury. Surgeons found dissections of 4 arteries in the neck. A month later, she remains paralyzed and is still in the ICU.
I’ve been following the news reports about Caitlin Jensen, who remains paralyzed in the ICU a month after a visit to her chiropractor. She is a 28-year-old woman who had just graduated from Georgia Southern University in May with a master’s degree in chemistry and biology.
The first report I read, from Yahoo, said “It’s unclear if Jensen’s injury occurred before or during the appointment with her chiropractor.” The news stories repeated many of the same details and quotations from family members but lacked important information. I read everything I could find online, and here’s how I pieced it together.
On June 16 she visited a chiropractor in Savannah. Although most news stories did not name him, one did. I won’t. He has refused to comment, saying HIPAA rules do not allow him to divulge patient information. Apparently the reason for her visit to the chiropractor was “neck stiffness,” which she attributed to long periods of studying for exams. (But one report says she went for treatment of back pain?!) The exact sequence of events is not clear, but Caitlyn’s mother says the chiropractor phoned her to tell her he had called 911 and an ambulance was taking Caitlyn to the hospital because she had had a bad reaction to his treatment.
She went into a coma, had a cardiac arrest, and was pulseless for 10 minutes.
The surgeons were able to revive her. They found dissections of 4 arteries in the neck, repaired some of the tears, and inserted a stent in one artery. (A dissection is a tear in the inner lining of the artery. The resulting accumulation of blood can lead to blood clots, interference with blood flow, and strokes.) There are 4 main arteries in the neck, 2 vertebral and 2 carotid arteries, so it sounds like all 4 had dissections.
After a month, she is still unable to speak and can only wiggle her left toes and blink her eyes; the rest of her body remains paralyzed. In addition to the paralysis, she also suffered a traumatic brain injury. The family has established a GoFundMe page where they post regular updates on her condition. It has already raised over $60,000 to help pay for her treatment.
All the doctors who treated Caitlin were convinced that chiropractic neck manipulation was the cause of the dissections.
The risk of stroke with neck manipulation has been covered many times on SBM.
“adds to the growing body of evidence that neck manipulation is an independent risk factor for cervical arterial dissection and stroke. The authors conclude:
Based on our findings, all patients who visited chiropractors for cervical spine manipulation should be informed of the potential risks and of the need to seek immediate medical assistance should symptoms suggestive of dissection or stroke occur during or after manipulation.
In fact, they suggested that patients might well avoid chiropractors altogether:
Until the actual level of risk from chiropractic manipulation is known, patients with neck pain may be better served by equally effective passive physical therapy exercise.
Keep in mind that chiropractors manipulate necks to correct “chiropractic subluxations” that have never been shown to exist.
It’s fascinating to read all the comments following the online articles about Caitlin Jensen. Satisfied patients rave about what chiropractors have done to help them, often claiming dramatic cures from treatments that have been tested in controlled studies and shown not to work. Dissatisfied patients complain that chiropractic treatment either didn’t help or made them worse. Some chiropractors accept that neck manipulation can cause strokes but insist that this is exceedingly rare, estimated at 0.05 to 1.46 strokes in every ten million neck manipulations. Since they believe that neck manipulations are effective, they apparently think the very small risk is acceptable. Other chiropractors deny that there is any risk at all. They argue that these patients already had dissections in the arteries of their necks and that was the reason they had neck pain and visited the chiropractor. But it seems to me that if a patient already had a tear in a vertebral artery, the very worst thing you could do is subject the neck to rapid-thrust manipulations that would only put more stress on that artery and increase the damage.
There is no reliable way to predict which patients are at risk of stroke. And chiropractors are not able to diagnose or treat a vertebral artery dissection; for that, sophisticated imaging facilities and medical and surgical specialists are required. It has been argued that there is no longer any place for chiropractors in modern medicine, since physical therapists can do everything a chiropractor does. And they try to base their treatments on scientific evidence rather than on a prescientific superstition.
Chiropractors remind us that spontaneous dissections can occur in the vertebral arteries, as in the so-called beauty parlor strokes where the neck is hyperextended for a shampoo. Spontaneous dissections occurring simultaneously in all 4 neck arteries are so rare that they warrant case reports like this one where a stroke was caused by intractable vomiting.
A review by Edzard Ernst concluded “With the possible exception of back pain, chiropractic spinal manipulation has not been shown to be effective for any medical condition.” The risk of stroke from neck manipulation is uncertain, but a significant risk can’t be ruled out, and there may be massive under-reporting because chiropractors are not required to report strokes and may not even be aware that a patient has had a stroke following neck manipulation.
Conclusion: The risk/benefit ratio is not favorable
Since the high velocity low amplitude (HVLA) neck manipulations typically used by chiropractors have not been proven effective for anything, and since significant risk can’t be ruled out, accurate evaluation of the risk/benefit ratio is impossible, and patients can’t give truly informed consent. The prudent course would be to avoid rapid-thrust neck manipulations and use other treatments that have been proven effective, including gentle mobilization.
This article was originally published in the Science-Based Medicine Blog.