Association between cervical artery dissection and spinal manipulative therapy –a medicare claims analysis

作者：James M. Whedon, Curtis L. Petersen, Zhongze Li, William J Schoelkopf, Scott Haldeman, Todd A. MacKenzie, Jon D. Lurie · 发表于：BMC Geriatrics · 年份：2022 · DOI：10.1186/s12877-022-03495-5 · 被引用次数：16 · 研究领域：Cervical and Thoracic Myelopathy、Intracranial Aneurysms: Treatment and Complications、Spinal Fractures and Fixation Techniques

BACKGROUND: Cervical artery dissection and subsequent ischemic stroke is the most serious safety concern associated with cervical spinal manipulation. METHODS: We evaluated the association between cervical spinal manipulation and cervical artery dissection among older Medicare beneficiaries in the United States. We employed case-control and case-crossover designs in the analysis of claims data for individuals aged 65+, continuously enrolled in Medicare Part A (covering hospitalizations) and Part B (covering outpatient encounters) for at least two consecutive years during 2007-2015. The primary exposure was cervical spinal manipulation; the secondary exposure was a clinical encounter for evaluation and management for neck pain or headache. We created a 3-level categorical variable, (1) any cervical spinal manipulation, 2) evaluation and management but no cervical spinal manipulation and (3) neither cervical spinal manipulation nor evaluation and management. The primary outcomes were occurrence of cervical artery dissection, either (1) vertebral artery dissection or (2) carotid artery dissection. The cases had a new primary diagnosis on at least one inpatient hospital claim or primary/secondary diagnosis for outpatient claims on at least two separate days. Cases were compared to 3 different control groups: (1) matched population controls having at least one claim in the same year as the case; (2) ischemic stroke controls without cervical artery dissection; and (3) case-crossove...