{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T02:51:21Z","timestamp":1789440681440,"version":"build-2803163510"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2001,5]]},"abstract":"<jats:p>\n            <jats:italic>Background and Purpose<\/jats:italic>\n            \u2014Several reports have linked chiropractic manipulation of the neck to dissection or occlusion of the vertebral artery. However, previous studies linking such strokes to neck manipulation consist primarily of uncontrolled case series. We designed a population-based nested case-control study to test the association.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods<\/jats:italic>\n            \u2014Hospitalization records were used to identify vertebrobasilar accidents (VBAs) in Ontario, Canada, during 1993\u20131998. Each of 582 cases was age and sex matched to 4 controls from the Ontario population with no history of stroke at the event date. Public health insurance billing records were used to document use of chiropractic services before the event date.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Results<\/jats:italic>\n            \u2014Results for those aged &lt;45 years showed VBA cases to be 5 times more likely than controls to have visited a chiropractor within 1 week of the VBA (95% CI from bootstrapping, 1.32 to 43.87). Additionally, in the younger age group, cases were 5 times as likely to have had \u22653 visits with a cervical diagnosis in the month before the case\u2019s VBA date (95% CI from bootstrapping, 1.34 to 18.57). No significant associations were found for those aged \u226545 years.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014While our analysis is consistent with a positive association in young adults, potential sources of bias are also discussed. The rarity of VBAs makes this association difficult to study despite high volumes of chiropractic treatment. Because of the popularity of spinal manipulation, high-quality research on both its risks and benefits is recommended.\n          <\/jats:p>","DOI":"10.1161\/01.str.32.5.1054","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:10:52Z","timestamp":1308341452000},"page":"1054-1060","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":244,"title":["Chiropractic Manipulation and Stroke"],"prefix":"10.1161","volume":"32","author":[{"given":"Deanna M.","family":"Rothwell","sequence":"first","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.M.R., S.J.B., J.I.W.); Departments of Public Health Sciences (S.J.B., J.I.W.), Family and Community Medicine (J.I.W.), and Continuing Education (J.I.W.), University of Toronto; and Sunnybrook and Women\u2019s College Health Sciences Centre (J.I.W.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan J.","family":"Bondy","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.M.R., S.J.B., J.I.W.); Departments of Public Health Sciences (S.J.B., J.I.W.), Family and Community Medicine (J.I.W.), and Continuing Education (J.I.W.), University of Toronto; and Sunnybrook and Women\u2019s College Health Sciences Centre (J.I.W.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Ivan","family":"Williams","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.M.R., S.J.B., J.I.W.); Departments of Public Health Sciences (S.J.B., J.I.W.), Family and Community Medicine (J.I.W.), and Continuing Education (J.I.W.), University of Toronto; and Sunnybrook and Women\u2019s College Health Sciences Centre (J.I.W.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","unstructured":"Coroner\u2019s Inquiry into the Death of Laurie Jean Mathiason: Transcript of Inquest. Saskatoon Saskatchewan: Meyer Compu Court Reporting; 1998."},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01654447"},{"key":"e_1_3_2_3_2","first-page":"38","volume":"163","year":"2000","unstructured":"Norris JW, Beletsky V, Nadareishvili ZG. Sudden neck movement and cervical artery dissection. 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