ABSTRACT
We analyzed the clinical course and neuroradiological findings of ten patients aged 27-46 years, with ischemic stroke secondary to vertebral artery dissection (VAD; n = 8) or internal carotid artery dissection (CAD; n = 2), all following chiropractic manipulation of the cervical spine. The following observations were made: (a) All patients had uneventful medical histories, no or only mild vascular risk factors, and no predisposing vascular lesions. (b) VAD was unilateral in five patients and bilateral in three. VAD was located close to the atlantoaxial joint in all eight patients and showed additional involvement of lower sections in six, as well as temporary occlusion of one vertebral artery in three. (c) Nine of ten patients had brain infarction documented by magnetic resonance imaging or computed tomography. (d) Onset of symptoms was immediately after the manipulation (n = 5) or within 2 days (n = 5). (e) Progression of neurological deficits occurred within the following hours to a maximum of 3 weeks. (f) Maximum neurological deficits were severe in nine of ten patients. (g) Outcome after 4 weeks-3 years included no or mild neurological deficits in five patients, marked deficits in three, persistent locked-in syndrome in one, and persistent vegetative state in one. (h) Informed consent was obtained in only one of ten patients. Thus, patients at risk for stroke after chiropractic manipulation may not be identified a priori. Neurological deficits may be severely disabling and are potentially life threatening.
Subject(s)
Cerebrovascular Disorders/etiology , Manipulation, Spinal/adverse effects , Neck/innervation , Adult , Aortic Dissection/etiology , Carotid Artery Diseases/etiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment Outcome , Vertebral ArteryABSTRACT
Surgery to effect synostosis between fibula and tibia is to be considered if it is not possible to bridge a relatively large gap at the tibia directly at the site of the defect by autologous (cortico)-spongiosaplasty because of inflammatory complications. Various modifications of the procedure are possible--they are described in the article--but the authors are of the opinion that preference should be given to synostosis which leaves the fibula at its physiological site. Technical details are given and the pros and cons discussed. This article is based on the experience collected during the treatment of eight patients.
