Vertebrobasilar dissection and cervical spine manipulation A complex pain in the neck

Chiropractic adjustment and manipulation are widely used to treat a variety of musculoskeletal complaints. The number of chiropractors in the U.S. is expected to nearly double in this decade,1 and it is estimated that chiropractic visit rates are at least 100 per 100 person-years in the U.S., with nearly 85% of these involving adjustment or manipulation of the spine.2 As use of chiropractic treatments has increased, so have demands for scientifically rigorous studies examining the risks and benefits of various chiropractic procedures. Prior to 2002, there were at least three randomized trials of cervical manipulation for patients with acute neck pain. However, the number of patients in these studies was small, and the quality of the studies, as judged by standardized criteria, was low.3 Recently, a large and well-designed randomized clinical trial showed that cervical manipulation (controlled dynamic thrust applied with high-velocity, low-amplitude force) was no better than mobilization (low velocity, variable …