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Croft AC: Treatment paradigm for cervical acceleration/deceleration injuries (whiplash). ACA Journal of Chiropractic, 30(1): 41-45, 1993.
Abstract
Standards of care are the watchwords of the 1990s. With regard to treatment frequency and duration of care, two areas of chief concern are workers’ compensation and personal injury. This paper offers a rational method for determining a reasonable treatment paradigm for cervical acceleration/deceleration trauma based on preliminary data from studies currently underway at the Spine Research Institute of San Diego.
Croft AC, Young DN: Videofluoroscopy: a sampling of chiropractic radiologist's opinions. Topics in Diagnostic Radiology and Advanced Imaging, 2(1): 4-10, 1994.
Abstract
Videofluoroscopy (VF), previously known as cineradiography, has long been a source of polemics in our profession. Researchers in the 1970s concluded that VF was somewhat unreliable due primarily to technical difficulties related to patient positioning and geometric distortion. Due to these criticisms and a concern about inadequate training, the lack of normative data on intersegmental motion, the lack of standardized technique and patient selection protocol, as well as a concern for patient exposure to ionizing radiation, the American Chiropractic College of Radiology (ACCR) adopted a rather restrictive position on VF. More recently the ACCR has modified and relaxed its position in regard to VF, but not all practitioners are aware of these guidelines and few refer patients for VF evaluation. At this institute we have looked into the issue of interinterpreter reliability and we have candidly surveyed the attitudes of several of our most prominent radiologists. In this paper we shall discuss our findings and review salient parts of the most recent (1991) ACCR position on VF.
Key words: Videofluoroscopy.
Croft AC: Proposed classification of cervical acceleration/deceleration (CAD) injuries with a review of prognostic research. Palmer Journal of Research, 1(1): 10-21, 1994
Croft AC: Appropriateness of cervical spine manipulation: a survey of practitioners. Chiropractic Technique 8(4):178-181, 1996.
Abstract
OBJECTIVE To survey chiropractic field practitioners to determine the prevailing practices of cervical spine manipulation in patients known to have or suspected of having herniated or protruded cervical intervertebral discs. Design Postal survey mailed to all licensed chiropractors in the U.S. (n = ~ 50,200). PARTICIPANTS The number of licensed chiropractors responding to the survey was 3,510. MAIN RESULTS The mean age of the respondents was 42 yr (87% men) and the mean number of yr in practice was 13. Less than 2% of the respondents never perform manual manipulation to the cervical spine and 93% of all respondents reported that they would manipulate the spines of patients either known to have or suspected to have cervical disc herniation. Sixty-seven percent would attempt to directly manipulate the involved segment. CONCLUSIONS Although it is not possible to determine whether the respondents to the survey were a representative sample of practicing chiropractors in the United States, the majority reported that they will manipulate the cervical spines of patients who are at least suspected of having herniated cervical intervertebral discs.
Key words: Chiropractic, cervical vertebrae, intervertebral disc.
Sehnert K, Croft AC: Basal metabolic temperature vs. laboratory assessment in posttraumatic hypothyroidism. JMPT 19(1):6-12, 1996.
Abstract
OBJECTIVES To compare standard laboratory analytical methods with measurement of basal metabolic temperature in cases of hypothyroidism arising posttraumatically. SETTING Private medical office. SUBJECTS One hundred and one consecutive status post-whiplash trauma patients. DESIGN All subjects were evaluated with standard laboratory tests (T3RU, T4, FT4I, TSH) for thyroid function. Ninety-four were also evaluated with the newer fluorescence-activated microsphere assay test (FAMA) and basal metabolic temperature (BMT) was measured in all. Correlations were investigated between BMT, age, gender, standard laboratory values and the FAMA test. The differences between low and high BMT vs. normal and abnormal standard laboratory values and the differences between normal and abnormal standard laboratory values vs. normal and elevated FAMA test results were also investigated. RESULTS In 86.4%, the BMTs were below normal. Of this subgroup, 30% had abnormal standard laboratory values. Of the 13% whose BMT was within the normal range, 33% had abnormal standard laboratory values and 66% had increased FAMA titers. Statistically significant correlation was found between BMT and T3RU (p = .05), whereas the correlation between BMT and T4 was somewhat weaker (p = .07). Correlations between BMT and all other laboratory indices failed to reach significance. The laboratory abnormalities observed in this group of subjects were atypical for common types of hypothyroidism. A significant portion of our posttraumatic hypothyroid group (30%) were not identified with either standard laboratory tests or the FAMA test-a group we referred to as lab-normal. CONCLUSIONS Measurement of BMT seems to be a sensitive screening test, in combination with laboratory analysis, for the hypothyroidism seen after whiplash trauma. Whiplash seems to result in a form of hypothyroidism suggesting direct injury to central tissues.
Freeman MD, Croft AC, Rossignol AM: "Whiplash-Associated Disorders (WAD)—Redefining Whiplash and its management" by the Quebec Task Force: A critical evaluation. Spine 23(9):1043-1049, 1998.
Abstract
STUDY DESIGN The two publications of the Quebec Task Force on Whiplash-Associated Disorders were evaluated by the authors of this report for methodologic error and bias. OBJECTIVES To determine whether the conclusions and recommendations of the Quebec Task Force on Whiplash-Associated Disorders regarding the natural history and epidemiology of whiplash injuries are valid. SUMMARY OF THE BACKGROUND DATA: In 1995, the Quebec Task Force authored a text (published by the Societe de l'Assurance Automobile du Quebec) and a pullout supplement in Spine entitled "Whiplash-Associated Disorders: Redefining Whiplash and its Management." The Quebec Task Force concluded that whiplash injuries result in "temporary discomfort," are "usually self-limited," and have a "favorable prognosis," and that the "pain [resulting from whiplash injuries] is not harmful." METHODS The authors of the current report reviewed the text and the supplement for methodologic flaws that may have threatened the validity of the conclusions and recommendations of the Quebec Task Force. RESULTS Five distinct and significant categories of methodologic error were found. They were: selection bias, information bias, confusing and unconventional use of terminology, unsupported conclusions and recommendations, and inappropriate generalizations from the Quebec Cohort Study. CONCLUSION The validity of the conclusions and recommendations of the Quebec Task Force regarding the natural course and epidemiology of whiplash injuries is questionable. This lack of validity stems from the presence of bias, the use of unconventional terminology, and conclusions that are not concurrent with the literature the Task Force accepted for review. Although the Task Force set out to redefine whiplash and its management, striving for the desirable goal of clarification of the numerous contentious issues surrounding the injury, its publications instead have confused the subject further.
Croft AC, The Neck Injury Criterion (NIC): Future Considerations. 44th Annual Proceedings of the Association for the Advancement of Automotive Medicine, Chicago, IL, October 1-4, 2000, 519-521.
Freeman MD, Croft AC, Rossignol AM, Weaver DS, Reiser M: A review and methodological critique of the literature refuting whiplash syndrome. Spine 24(1):86-96, 1999.
Abstract
The validity of whiplash syndrome has been a source of debate in the medical literature for many years. Some authors have published articles suggesting that whiplash injuries are impossible at certain collision speeds; others have stated that the problem is psychological, or is feigned as a means to obtain secondary financial gain. These articles contradict the majority of the literature, which shows that whiplash injuries and their sequelae are a highly prevalent problem that affects a significant proportion of the population. The authors of the current literature critique reviewed the biomedical and engineering literature relating to whiplash syndrome, searching for articles that refuted the validity of whiplash injuries. Twenty articles containing nine distinct statements refuting the validity of whiplash syndrome were found that fit the inclusion criteria. The methodology described in these articles was evaluated critically to determine if the authors' observations regarding the validity of whiplash syndrome were scientifically sound. The authors of the current critique found that all of the articles contained significant methodologic flaws with regard to their respective authors' statements refuting the validity of whiplash syndrome. The most frequently found flaws were inadequate study size, nonrepresentative study sample, nonrepresentative crash conditions (for crash tests), and inappropriate study design. As a result of the current literature review, it was determined that there is no epidemiologic or scientific basis in the literature for the following statements: whiplash injuries do not lead to chronic pain, rear impact collisions that do not result in vehicle damage are unlikely to cause injury, and whiplash trauma is biomechanically comparable with common movements of daily living.
Harrison DD, Harrison SO, Croft AC, Harrison DE, Troyanovich SJ: Sitting biomechanics, part I: review of the literature. JMPT 22(9):594-609, 1999.
Abstract
OBJECTIVE To develop a new sitting spinal model and an optimal driver's seat by using review of the literature of seated positions of the head. spine, pelvis, and lower extremities. DATA SELECTION Searches included MEDLINE for scientific journals, engineering standards, and textbooks. Key terms included sitting ergonomics, sitting posture, spine model, seat design, sitting lordosis, sitting electromyography, seated vibration, and sitting and biomechanics. DATA SYNTHESIS In part I, papers were selected if (1) they contained a first occurrence of a sitting topic, (2) were reviews of the literature, (3) corrected errors in previous studies, or (4) had improved study designs compared with previous papers. In part II, we separated information pertaining to sitting dynamics and drivers of automobiles from part 1. RESULTS Sitting causes the pelvis to rotate backward and causes reduction in lumbar lordosis, trunk-thigh angle, and knee angle and an increase in muscle effort and disc pressure. Seated posture is affected by seat-back angle, seat-bottom angle and foam density, height above floor, and presence of armrests. CONCLUSION The configuration of the spine, postural position, and weight transfer is different in the 3 types of sitting: anterior, middle, and posterior. Lumbar lordosis is affected by the trunk-thigh angle and the knee angle. Subjects in seats with backrest inclinations of 110 to 130 degrees, with concomitant lumbar support, have the lowest disc pressures and lowest electromyography recordings from spinal muscles. A seat-bottom posterior inclination of 5 degrees and armrests can further reduce lumbar disc pressures and electromyography readings while seated. To reduce forward translated head postures, a seat-back inclination of 110 degrees is preferable over higher inclinations. Work objects, such as video monitors, are optimum at eye level. Forward-tilting, seat-bottom inclines can increase lordosis, but subjects give high comfort ratings to adjustable chairs, which allow changes in position.
Harrison DD, Harrison SO, Croft AC, Harrison DE, Troyanovich SJ: Sitting biomechanics, part II: optimal car driver’s seat and optimal driver’s spinal model. JMPT 23(1):37-47, 2000.
Abstract
BACKGROUND Driving has been associated with signs and symptoms caused by vibrations. Sitting causes the pelvis to rotate backwards and the lumbar lordosis to reduce. Lumbar support and armrests reduce disc pressure and electromyographically recorded values. However, the ideal driver's seat and an optimal seated spinal model have not been described. OBJECTIVE To determine an optimal automobile seat and an ideal spinal model of a driver. DATA SOURCES Information was obtained from peer-reviewed scientific journals and texts, automotive engineering reports, and the National Library of Medicine. CONCLUSION Driving predisposes vehicle operators to low-back pain and degeneration. The optimal seat would have an adjustable seat back incline of 100 degrees from horizontal, a changeable depth of seat back to front edge of seat bottom, adjustable height, an adjustable seat bottom incline, firm (dense) foam in the seat bottom cushion, horizontally and vertically adjustable lumbar support, adjustable bilateral arm rests, adjustable head restraint with lordosis pad, seat shock absorbers to dampen frequencies in the 1 to 20 Hz range, and linear front-back travel of the seat enabling drivers of all sizes to reach the pedals. The lumbar support should be pulsating in depth to reduce static load. The seat back should be damped to reduce rebounding of the torso in rear-end impacts. The optimal driver's spinal model would be the average Harrison model in a 10 degrees posterior inclining seat back angle.
Croft AC, Herring P, Freeman MD, Haneline MT: The neck injury criterion (NIC): future considerations. Accid Anal Prev 34(2)247-255, 2002.
Abstract
The cost of whiplash injuries—both in dollars spent for medical care and disability, and in terms of human suffering—are quite high in westernized nations. This is of particular interest, both from a public health perspective and a general societal one, because the disorder is theoretically preventable: In the very least it can be minimized. This can be achieved with crash prevention strategies and improvements in vehicle safety design—especially with more effective seat back and head restraint systems. Toward the goal of developing a standard for safety research in this area, a neck injury criterion (NIC) was proposed by Boström et al. in 1996. This criterion considers the relative horizontal acceleration and velocity between the bottom (T1) and top (C1) of the cervical spine and has face validity based on current literature. However, the NIC has become almost universally accepted, yet has not been subjected to rigorous scientific investigation or validation in terms of its representativeness in human occupant injury. Such investigation should specifically consider, first, whether the NIC provides an adequate proxy for all potential neck injuries due to whiplash and, secondly, whether the proposed threshold value of 15 m2/s2 is representative of the potential for all types of acute injuries. Based on a review of recent literature, recent human volunteer crash tests by Wheeler et al. and the those of the Spine Research Institute of San Diego, and based on mathematical MADYMO analysis of real world crash pulse data, it appears that the threshold for all acute injury in the general population is likely to require a lowering of the originally proposed NIC value. Moreover, it may be necessary to consider other factors not currently defined with the NIC, such as global neck hyperextension and the negative portion of the NIC curve. The conclusions of this paper should be considered preliminary. Certainly, ongoing work will be necessary to investigate this further and further analysis of more onboard crash data will prove invaluable.
Key words: Neck injury criterion (NIC)/whiplash/motor vehicle crash/cervical acceleration/deceleration injury (CAD).
Freeman MD, Centeno C, Croft AC, Nicodemus CN: Significant spinal injury resulting from low-level accelerations: a comparison with whiplash. International Congress on Whiplash-Associated Disorders, Berne, Switzerland, March 9-10, 1, 2001.
Abstract
BACKGROUND The level of force at which significant spinal injury can occur is a topic that has generated much discussion in the literature over the past 30 years. Research pertaining to human injury thresholds is best accomplished with observational study; that is, analysis of real world events. An ideal opportunity for study is presented with amusement park rides; roller coasters in particular, as they deliver a near identical level of acceleration to hundreds of thousands of subjects over a period of years. METHODS Injury incident records kept by the operators of the Rattler Roller coaster for the period 3-28-92 through 10-22-93 (approximately 19 months) were examined for significant spinal injuries that occurred on the ride. Emergency medical response and medical records that pertained to the incident records were also identified and reviewed. RESULTS A total of 39 subjects (out of an estimated 300,000 riders) with significant spinal injuries were found, yielding an injury rate of 13/100,000 exposures. The injuries were as follows; 72% (28 of 39) were single or multilevel cervical disc herniations, 23% were lumbar or thoracolumber disc herniations (9 of 39), and 18% were spinal fractures (seven cases, one cervical and six lumbar). The average Body Mass Index (BMI) was 23.1 (SD=4.4) for the females and 22.6 (SD=3.7) for the males, indicating average height and weight of the subjects. CONCLUSIONS While the injury rate was quite low in the study cohort (one in 7700 riders), it is reasonable to assume that the injury frequency among the self-selected and prepared riders of the roller coaster was lower than that of real world motor vehicle occupants exposed to similar acceleration levels in 3-4 mph rear impact collisions. The present study illustrates the fallacy of determining crash injury potential solely by estimating the level of peak occupant acceleration.
Croft AC, Haneline MT, Freeman MD: Differential occupant kinematics and head linear acceleration between frontal and rear automobile impacts at low speed: evidence for a differential injury risk. International Congress on Whiplash-Associated Disorders, Berne, Switzerland, March 9-10, 28, 2001.
Abstract
BACKGROUND Most epidemiological and clinical studies have highlighted the increased injury risk in rear impact vector crashes vs those of other vectors. However, many other risk factors exist which might potentially confound the observations of these studies. These include gender, age, stature, occupant positioning, and differences between vehicle parameters, such as head restraints, vehicle mass, etc. OBJECTIVE We conducted full scale, human subject crash tests under controlled conditions, using the same vehicles, the same subjects, and the same instrumentation, comparing occupant kinematics in rear vs. frontal crash scenarios. MATERIALS AND METHODS Vehicles and occupants were instrumented with accelerometers and closing speeds and delta Vs were measured. High speed video analysis was performed, and subjective responses to each crash were recorded. RESULTS The frontal vector crash resulted in a relatively simple, monophasic occupant kinematic, whereas the rear vector crash resulted in a more complex, biphasic kinematic. Subjects also rated the rear impact crashes notably less tolerable and more likely to cause injury. CONCLUSIONS Even in the same vehicle and at the same crash speeds, rear impact crash vectors result in comparatively more complex occupant kinematics, which seems to agree with epidemiological and clinical risk assessment data that suggests a greater risk in rear vector crashes vs. those of frontal or side impact vectors.
Key words: whiplash/WAD/cervical spine injury/human subjects testing.
Croft AC, Haneline MT, Freeman MD: Automobile crash reconstruction in low speed rear impact crashes utilizing a momentum, energy, and restitution (MER) method. International Congress on Whiplash-Associated Disorders, Berne, Switzerland, March 9-10, 20, 2001.
Abstract
BACKGROUND AND OBJECTIVE Low speed automobile crash reconstruction is fraught with difficulties. Residual crush, which is used in many reconstruction software programs, is often minimal or non-existent, police reports are rarely available, and witness accounts are generally unreliable. Many modern passenger vehicles can withstand crashes at closing velocities from other passenger vehicles at speeds of up to 15 km/h without sustaining significant damage, and yet the suspected risk threshold for occupants occurs at lower speeds. MATERIALS AND METHODS Using a method reported by Siegmund et al., in which bumper isolator travel is used to estimate energy and restitution values for use in momentum equations, we compared the results obtained mathematically to the actual data obtained from speed traps and accelerometers in two series’ of staged rear impact crash tests, utilizing multiple vehicles at low crash speeds. RESULTS The method was unsatisfactory when one of the two crashed cars had foam bumpers, and tended to yield values for delta V that were either close to the true value or about half, depending on vehicle make. The speed change, however, was never overestimated. When both cars were equipped with isolators, our results were difficult to interpret due to problems with frozen and broken isolators. CONCLUSIONS In real world crash reconstructions, the MER method may provide some guidance in estimating crash speed changes for subject vehicles. However, the method seemed to have only marginal practicality and accuracy. A larger series, with statistical analytical methods will be necessary to definitively determine the utility of this method.
Key words: Automobile crash reconstruction/ crash testing/ low speed crashes.
Centeno C, Freeman MD, Croft AC: A comparison of the functional profile of an international cohort of whiplash injured patients and non-patients: an internet study. International Congress on Whiplash-Associated Disorders, Berne, Switzerland, March 9-10, 2, 2001.
Freeman MD, Nicodemus CN, Croft AC, Centeno C: Significant spinal injury resulting from low-level accelerations: a case series of roller coaster injuries. Cervical Spine Research Society 29th Annual Meeting, Monterey, CA, Nov 29-Dec 1, 2001.
Abstract
STUDY DESIGN A prospective case series of roller coaster ride-induced significant spinal injuries. OBJECTIVES To describe a cohort of significantly injured roller coaster riders and the likely levels of acceleration at which the injuries occurred. These data are compared with contemporary efforts to define a lower limit of acceleration below which no significant spinal injury is likely to occur. METHODS Injury incident records and emergency medical service records for the Rattler Roller Coaster in San Antonio, Texas were evaluated for a 19 month period in 1992-3. Medical records for the more significant injuries were also reviewed and the specific injuries were tabulated, along with the demographics of the cohort. RESULTS There were 932,000 riders of the Rattler roller coaster, estimated to represent between 300,000 and 600,000 individual riders. It is estimated that there were a total of 656 neck and back injuries during the study period, and 39 were considered significant by the study inclusion criteria. Seventy two percent of the injured subjects sustained a cervical disc injury (28 of 39), and 71% of these injuries were at C5-6 (15 HNP, 5 symptomatic disc bulges), while 54% were at C6-7 (11 HNP, 4 symptomatic disc bulges). In the lumbar spine, the most frequent injury was a symptomatic disc bulge (20% of the cohort), followed by vertebral body compression fracture (18%), and L4-5 or L5-S1 HNP (13%). Accelerometry testing of passengers and train cars indicated a peak of 4.5-5g of vertical or axial acceleration and 1.5g of lateral acceleration over approximately 100 msec (0.1 sec) on both. CONCLUSIONS The results of this study suggest that there is no established minimum threshold of significant spine injury, and that the greatest explanation for injury presence following traumatic loading of the spine is individual susceptibility to injury, an unpredictable variable.
Key Words: Cervical spine, disc herniation, whiplash, roller coaster.
Freeman MD, Sapir D, Boutselis A, Gorup J, Tuckman G, Croft AC, Centeno C, Phillips A: Whiplash injury and occult vertebral fracture: a case series of bone SPECT imaging of patients with persisting spine pain following a motor vehicle crash. Cervical Spine Research Society 29th Annual Meeting, Monterey, CA, Nov 29-Dec 1, 2001.
Abstract
INTRODUCTION The pathology of chronic whiplash injury continues to be a controversial subject in the literature, with some authors claiming that long term pain following whiplash is a factitious disorder. These claims are made despite a growing canon of research demonstrating the cervical zygapophysis as a primary source of pain in approximately half of all chronic whiplash cases. Other research suggests that the intervertebral disc may be a source of continuing pain, associated with so-called rim lesions and other disc injuries. The pathomechanics of whiplash resulting from a rear impact collision include both segmental hyperextension in the lower cervical spine during the initial rearward movement of the head as well as flexion following the rebound of the head off of the head restraint, suggesting forceful loading of both posterior and anterior elements of the cervical spine. Recent cadaver testing of simulated whiplash has resulted in findings of injuries including fracture of both the vertebral body and elements of the neural arch, leading to the supposition that bony injury can occur with both the extension and flexion phases of whiplash trauma. While plain x-ray with lateral flexion and extension views is the generally recognized standard for evaluating bony injury and instability following whiplash, it is not particularly sensitive for the presence of incomplete cortical disruption such as endplate fractures and subchondral fractures of the facet. In the current investigation, we undertook bone scan and SPECT evaluation of consecutive patients who were referred for significant refractory pain following whiplash trauma based on the hypothesis that there may be a subpopulation of these patients who have continued symptoms resulting from unhealed occult fracture. METHODS Following Institutional Review Board approval of the study protocol, 15 consecutive patients who were referred for orthopedic evaluation of spine pain secondary to a motor vehicle crash (MVC), with symptoms that were un-responsive to conservative means of treatment such as physical therapy, chiropractic, and rehabilitation exercises, were subsequently referred for bone scan and SPECT imaging of their cervical and thoracic spine. The bone scans and SPECT images were read by two radiologists, blinded with regard to each other's findings as well as to the patients' symptom patterns. The results of the bone scan and SPECT imaging were compared to the patients' prior imaging studies (including plain x-ray and MRI) as well as their symptom pattern. Other details regarding patient demographics and the specifics of the MVC were tabulated. RESULTS Of the 15 referrals, one could not obtain insurance coverage for the study and thus did not undergo the diagnostic imaging. Of the remaining 14 subjects who were studied, ten had positive findings on bone scan and/orSPECT (71%). Nine of the ten positive studies closely corresponded with the patient-reported symptoms. The most frequent finding was vertebral endplate fracture, found in six cervical (60%) and three thoracic (30%) vertebrae. There were occult fractures identified in the lateral mass/lamina region of two cervical (20%) and two thoracic (20%) vertebra. A spinous process fracture was identified in the thoracic spine of one (10%) subject. There were ten females and four males in the study, with an average age of 33.3 (SD 9.0). The bone scan and SPECT imaging was performed an average of 18.9 months post-crash (SD 13.5, range 2-47). Pain levels were uniformly high, with average VAS scores of 7.8 (SD 1.1). Seven of the crashes were rear impact (50%), four were side impacts (29%), and three were front end impacts (21%). Nine of the occupants were drivers (64%) and ten were wearing seatbelts (71%). It did not appear that any of the fractures were a result of direct contact with the vehicle interior. None of the subjects had fractures that were detectable on plain film, even after reviewing the SPECT images and re-reading the radiographs. Ten of the subjects had MRI testing prior to the bone scan/SPECT protocol, and of these, six had signs of disc bulging in the cervical spine, four had disc bulges in the thoracic spine, and one had a frank thoracic herniation. One subject had undergone prior cervical discectomy and fusion, but had uptake activity in an area other than the healed fusion. DISCUSSION/CONCLUSION Our results, even though of a limited sample of patients, suggest a possible pathological mechanism at work in chronic whiplash that has not been previously described. While other authors have reported vertebral fractures resulting from whiplash trauma, none that we are aware of have suggested unhealed fractures as a potential source of chronic pain. Lack of specificity of bone scan and SPECT imaging for fracture may be a factor in our series, however, the high correlation of symptoms to findings suggests a traumatic rather than degenerative etiology. Greater subject numbers are needed in order to perform meaningful subgroup analyses relating to gender, age, and injury and crash details as risk factors for occult spinal fracture following whiplash. Our findings may point to more effective methods of dealing with chronic spine pain resulting from motor vehicle crashes.
Haneline MT, Croft AC, Frishberg BM: The association of internal carotid artery dissection and chiropractic manipulation. Neurologist 9(1):35-44, 2003.
ABSTRACT
BACKGROUND In order to determine the relationship between chiropractic manipulative therapy (CMT) and internal carotid artery dissection (ICAD), a Medline literature search was performed for the years 1966 through 2000, using the terms “internal carotid dissection.” Literature that included information concerning causation, and all case studies and series were selected for review. REVIEW SUMMARY In reviewing the few cases of internal carotid dissection proposed to be related to CMT, there were many contributing factors, such as connective tissue aberrations, underlying arteriopathy, or coexistent infection, that obscured any cause and effect relationship. To date there are only 13 reported cases of ICAD temporally related to CMT. Most ICADs appear to occur spontaneously and progress from local symptoms of headache and neck pain to cerebral hemispheric ischemic signs. Approximately one-third of the reported cases were manipulated by practitioners other than chiropractic physicians, and, due to the differential risk related to dissimilarity in training and practice between practitioners who manipulate the spine, it would be inappropriate to compare adverse outcomes between practitioner groups. CONCLUSIONS None of the cases reviewed in the medical literature indicated a clear causal relationship between CMT and ICAD. Reported cases have been exceedingly scarce, and are limited to case studies, which cannot be used to substantiate causation.
Key indexing terms: chiropractic manipulation, internal carotid artery dissection, stroke.
Freeman MD, Croft AC, Rossignol AM: Late whiplash risk factor analysis of a random sample of patients with chronic spine pain. Submitted.
Abstract
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