Skip Navigation LinksHome > February 15, 2008 - Volume 33 - Issue 4S > Risk of Vertebrobasilar Stroke and Chiropractic Care: Result...
doi: 10.1097/BRS.0b013e3181644600
Supplementary Research Studies

Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study

Cassidy, J David DC, PhD, DrMedSc*†‡; Boyle, Eleanor PhD*; Côté, Pierre DC, PhD*†‡§; He, Yaohua MD, PhD*; Hogg-Johnson, Sheilah PhD†§; Silver, Frank L. MD, FRCPC¶∥; Bondy, Susan J. PhD†



In the article that appeared on page S176 in the Supplement to the February 15, 2008 issue of Spine, there is an error in Table 5.1 In column 6, row 8, there is an odds ratio with a confidence interval of 5.18 (0.16-1.66) indicating the association between vertebrobasilar stroke and chiropractic treatment in patients over the age of 45 years, who had visited a chiropractor between 0-7 days with a diagnosis of headache or other cervical problem. That estimate is wrong and should read 0.52 (0.16-1.66).

Spine. 35(5):595, March 1, 2010.

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Study Design. Population-based, case-control and case-crossover study.

Objective. To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke.

Summary of Background Data. Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke.

Methods. Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls.

Results. There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged <45 years, cases were about three times more likely to see a chiropractor or a PCP before their stroke than controls. Results were similar in the case control and case crossover analyses. There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke.

Conclusion. VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

© 2008 Lippincott Williams & Wilkins, Inc.

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