Joseph S. Ferezy
International Academy of Chiropractic Neurology
Title: Cervical spinal manipulation and vertebrobasilar ischemia
Biography
Biography: Joseph S. Ferezy
Abstract
Spinal manipulation dates back to the time of Hippocrates and is increasingly being used in modern day practice of practitioners in the USA, particulary chiropractors, osteopaths and physiatrists. It is also increasing in use by a variety of providers internationally. This lecture will present relevant facts and issues in regard to the complex issue of cervical spinal manipulative therapy (CSMT) and any relation to a type of cerebrovascular accident (CVA) in the posterior cerebral circulation, known as vertebrobasilar ischemia (VBI). The talk will critically review landmark articles regarding CSMT and VBI. It will also discuss current estimations as to the incidence and prevalence of CMST realted VBI. A review of cerebrovascular anatomy and hemodynamics and proposed patho-physiological mechanisms believed to be responsible for VBI following CMST, in particular vertebral artery dissection (VAD). Risk factors and the efficacy of proposed tools to screen patients undergoing CSMT for VBI will be reviewed, as well as in-office recognition of evolving VBI and confirmatory imaging studies. Examples of anti-chiropractic bias in the popular media as well as in biomedical literature will be presented. Recommendations for providers who provide or refer for CMST will be made and a plan of action will be discussed. Developing evidence of increased plasma homocystine levels and potential case management considerations will also be discussed.