Putting Neck Pain Treatment Risks into Perspective
There are risks and benefits to all treatments; however, the chance of experiencing a serious adverse event following neck manipulation is extremely low.
The association between neck manipulation and vertebral artery dissection is about 1 in 5.85 million adjustments (less than 1 in 1 million 1). While it is impossible to make direct comparisons given likely differences in underlying patient demographics and co-morbidities, it is important to recognize that all healthcare treatments and procedures carry some association with adverse events. To put the association between neck manipulation and VAD in context, consider the following:
Overall risk of death from spine surgery: 1,800 per 1 million 2
Risk of serious side effects/death from cervical spine (neck) surgery: 500 per 1 million 3
Risk of death from combined use of NSAIDS/aspirin: 153 per 1 million 4
Risk of death from prescription opioid pain medications: 53.6 per 1 million 5
Risk of death from aspirin: 25 per 1 million 6
According to the Institute of Medicine, at least 1.5 million Americans are sickened, injured or killed each year by errors in prescribing, dispensing and taking medications. 7
Moreover, CDC has classified the abuse of prescription opioid pain medications in the U.S. as “epidemic.” In 2010, more than 15,000 people died as a result of taking these drugs. 8
Even over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen pose a greater risk than neck manipulation. One study estimated more than 100,000 patients are hospitalized every year for serious gastrointestinal complications resulting from their use. (There are over 16,000 NSAID-related deaths annually in the United States). 9
Doctors of chiropractic have some of the lowest malpractice insurance premiums in health care because of the low risk associated with the treatments they utilize.
1. Haldeman S, Carey P, Townsend M, Papadopoulos C: Arterial dissections following cervical manipulation: the chiropractic experience. CMAJ 2001;165:905.
2. Smith, JS et al. Rates and causes of mortality associated with spine surgery based on 108,419 procedures: a review of the Scoliosis Research Society Morbidity and Mortality Database. Spine 2012, Nov 1;37(23):1975-82.
3. Marquez-Lara A, Nandyala SV, Hassanzadeh H, Noureldin M, Sankaranarayanan S, Singh K: Sentinel Events in Cervical Spine Surgery. Spine 2014 Jan 29 [Epub ahead of print], http://www.ncbi.nlm.nih.gov/pubmed/24480955
4. Lanas A et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterology 2005, Aug;100(8):1685-93.
5. Email to ACA from Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, April 29, 2014.
6. Lanas A et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterology 2005, Aug;100(8):1685-93.
7. Preventing Medication Errors, Institute of Medicine, July 2006,
8. Office of National Drug Policy, Fact Sheet: Opiod Abuse in the United States,
9. Wolfe MM, Lichtenstein DR, Singh G: Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. NEJM 1999; 340:1888.