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Abstract
Complications of cervical spine manipulation (CSM) have been documented in the literature for over half a century. Most incidents involve neurovascular compromise resulting from trauma of the vertebral artery or less frequently the internal carotid artery. The determination of the incidence rate or degree of risk of this complication is of crucial importance in clinical decision making regarding CSM. To this end a critical review of published case reports and studies investigating the event rate of stroke associated with CSM is undertaken. It is concluded that the case reports in the literature are not representative of the frequency of neurovascular complications. Methodological limitations of past research on this topic are discussed, as is the need for a prospective study. Despite these considerations it is found that marked neurological sequelae to CSM are an uncommon event for which the level of risk may be further reduced by prudent practice.