Review of nine malpractice cases with allegations of causation of cervical artery dissection by cervical spine manipulation: No evidence for causation

Research shows no convincing evidence to support a causal link between cervical spine manipulation (CSM) and cervical artery dissection (CAD). Researchers have proposed that a belief in a causal link may have significant negative consequences such as numerous episodes of litigation. The objective of this study was to review 10 malpractice cases for evidence of unnecessary litigation due to a belief in a causal link between CSM and CAD.

A Google Scholar Case Law search from 1989 to 2024 was conducted to identify the 10 most recent English-language reports of malpractice cases involving an allegation that CSM caused CAD. Although our objective was to review 10 cases, only 9 cases were found.

In all cases, causation of CAD by CSM was not supported by the evidence. In 4 out 9 cases reviewed, causation of stroke by CSM was supported by the evidence. In all 9 cases reviewed, failure to diagnose an existing CAD was more likely than not but was not alleged.

We conclude that belief in a causal link between CSM and CAD does have negative consequences such as unnecessary litigation. In all 9 cases reviewed, allegations of failure to diagnose an existing CAD would have been more likely to result in a settlement without need for a trial.