Informed Consent Regarding Risk of Stroke from Cervical Spine Manipulation: A Narrative Review

Informed Consent Regarding Risk of Stroke from Cervical Spine Manipulation: A Narrative Review
Steven Brown, James J. Lehman
Journal of the International Academy of Neuromusculoskeletal Medicine, 2025
Open Access
Abstract
Objective
Although the incidence of stroke following cervical spine manipulation (CSM) is low, the potential outcomes are serious. The objective of this study was to perform a narrative review to assess whether informed consent to the risk of stroke from CSM is recommended by chiropractic researchers and practice guidelines.
Methods
An electronic literature search was conducted in February 2025 using PubMed, Google Scholar, and the Index to Chiropractic Literature, covering 1989 to March 2025. Search terms included chiropractic, cervical spine manipulation, stroke, informed consent, and risk. English language peer reviewed studies by chiropractic physicians, along with practice guidelines written in whole or in part by chiropractic physicians, were considered.
Results
There was unanimous support for informed consent to the risk of stroke from CSM in the results. We identified two practice guidelines, two case control studies, three narrative reviews, and one case series authored by chiropractic physicians that recommend such informed consent. We did not find any peer reviewed studies that argued against such informed consent.
Conclusions
Informed consent to the risk of stroke from CSM is recommended by practice guidelines and chiropractic researchers. This lends weight to the view that such informed consent is the standard of care for the chiropractic profession.