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Association of neurovascular events with cervical manual therapy: A cohort study

Journal: International Journal of Osteopathic Medicine Date: 2025/12, 58(online 2025/08/11):Pages: 100782. doi: Subito , type of study: cohort study

Full text    (https://www.journalofosteopathicmedicine.com/article/S1746-0689(25)00038-0/abstract)

Keywords:

adverse events [44]
cervical spine [271]
cohort study [80]
neurovascular complications [1]
OMT [3695]
osteopathic manipulative treatment [3717]

Abstract:

Background Manual therapy is frequently used in the treatment of cervical-spine conditions. Due to the critical neurovascular structures in the cervical region, there are potential risks associated. Methods The PearlDiver Patient Record Database was used to evaluate a cohort of patients with cervical-spine conditions between 2007 and 2011 using International Classification of Disease codes (721.x, 722.x, 723.x, 739.1). Current Procedural Terminology codes were used to identify Manual Therapy Techniques (97140), Osteopathic Manipulation (98925-98927), and Chiropractic Manipulation (98940-98942). Medical encounters for Vertebral-Basilar Artery Syndrome or Transient Ischemic Attack (ICD-9 435.x), Carotid or Vertebral Artery Dissection (ICD-9 443.21 & 443.24), Cerebral Artery Thrombosis or Embolus (ICD-9 434.x), or Arterial Occlusion with or without Cerebral Infarct (ICD-9 433.x) were assessed the same day, 14-days, 30-days, and 90-days following treatment exposure. For each event, prevalence ratios (PR) and 95% confidence intervals (CI) were calculated comparing those receiving manual therapy to those not. Results 4,781,968 unique patients (15.9%) were diagnosed with a cervical-spine condition, with 2,477,117 (51.8%) of these patients provided MT from 2007-2011. Patients provided MT had an 11% increased prevalence of arterial occlusion observed within 90-days post-intervention (PR: 1.11 95% CI 1.02-1.21, NNT Harm: 27,762) and a 11-45% lower prevalence of being diagnosed with a neurovascular complication 30-days (PR: 0.89, 95% CI 0.84-0.95), 14-days (PR = 0.82, 95% CI 0.76-0.88), and the same day (PR: 0.55, 95% CI 0.52-0.59) following treatment compared to patients not treated with MT. Conclusion This study presents population-level statistics on the occurrence of neurovascular complication after MT for cervical-spine conditions.


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