Chiropractic Malpractice Attorney New York: Stroke & Spinal Injuries

Vertebral Artery Dissection: The Catastrophic Chiropractic Injury

The vertebral arteries are two arteries that run through the cervical spine (neck vertebrae) — supplying blood to the brainstem, cerebellum, and posterior brain. During cervical spine manipulation — particularly high-velocity, low-amplitude (HVLA) thrust adjustments to the upper cervical spine (especially rotational adjustments) — the vertebral artery can be stretched, torn, or dissected.

Vertebral artery dissection (VAD) is a tear in the inner lining (intima) of the vertebral artery. When the intima tears: - Blood enters the vessel wall — forming a hematoma that narrows or blocks the artery. - A blood clot (thrombus) forms at the site of the tear. - The clot can break off and travel to the brain — causing a posterior circulation ischemic stroke. - Or the dissection can cause complete arterial occlusion — cutting off blood flow to the brainstem and cerebellum.

The result is a stroke — often affecting young, otherwise healthy patients who sought chiropractic care for neck pain or headaches. Vertebral artery dissection is one of the leading causes of stroke in patients under 45.

Key statistics:

• Vertebral artery dissection causes approximately 8-12% of ischemic strokes in young adults (under 45).
• Cervical spine manipulation is associated with VAD in an estimated 1 in 20,000 to 1 in 250,000 adjustments — though the true incidence may be higher due to underreporting.
• Up to 30% of patients who suffer VAD-related strokes after chiropractic manipulation die or are permanently disabled.
• The typical VAD patient is young (average age ~40), previously healthy, and sought chiropractic care for neck pain or headache.

How Chiropractic Adjustments Cause Stroke

Cervical spine manipulation — particularly rotational HVLA adjustments of the upper cervical spine (C1-C2, the atlas and axis) — can cause vertebral artery dissection through several mechanisms:

1. Mechanical stretch: The rotational thrust stretches the vertebral artery beyond its normal range — causing an intimal tear. The vertebral artery is most vulnerable at the C1-C2 level, where it makes a sharp turn around the atlas.

2. Direct compression: The adjustment can compress the vertebral artery against the cervical vertebrae — particularly at the atlantoaxial (C1-C2) junction.

3. Pre-existing vulnerability: Some patients have underlying connective tissue disorders (such as Ehlers-Danlos syndrome or fibromuscular dysplasia) that make their arteries more susceptible to dissection — and chiropractors must screen for these conditions.

4. Inadequate screening: The standard of care requires chiropractors to screen for risk factors before performing cervical manipulation — including a history of vascular disease, connective tissue disorders, severe headache, or neurological symptoms. Failure to screen and identify high-risk patients is a common breach.

5. Excessive force or improper technique: Using excessive rotational force, failing to stay within the normal range of motion, or applying HVLA thrusts to the wrong spinal level.

Recognizing VAD Symptoms After Neck Manipulation

Vertebral artery dissection symptoms may appear immediately after the adjustment — or develop over hours to days. The standard of care requires chiropractors to recognize the signs of VAD and immediately refer the patient for emergency neurological evaluation.

Red flag symptoms after cervical manipulation:

• Sudden severe headache — particularly a 'thunderclap' headache different from any previous headache.
• Neck pain — particularly pain that is new, severe, or different from the pre-existing complaint.
• Visual disturbances — double vision (diplopia), vision loss, or visual field cuts.
• Dizziness and vertigo — particularly with nausea and vomiting.
• Slurred speech (dysarthria) — difficulty speaking clearly.
• Facial numbness or weakness — on one side of the face.
• Arm or leg weakness — particularly on one side of the body.
• Difficulty swallowing (dysphagia) — or a feeling that something is 'stuck' in the throat.
• Loss of coordination (ataxia) — unsteady gait, clumsiness, or difficulty with fine motor tasks.
• Confusion or altered mental status.
• Loss of consciousness.

Other Chiropractic Injuries

While vertebral artery dissection is the most catastrophic chiropractic injury, other serious injuries can occur:

• Herniated disc: Excessive force during spinal manipulation can cause or worsen a herniated disc — compressing spinal nerves and causing radiculopathy (nerve pain, numbness, or weakness in the arms or legs). [Link to: /surgical-errors/nerve-damage]
• Cauda equina syndrome: Lumbar manipulation can cause or worsen a herniated disc that compresses the cauda equina (the bundle of nerve roots at the base of the spinal cord) — causing permanent paralysis, loss of bowel and bladder control, and sexual dysfunction. This is a surgical emergency. [Link to: /spinal-cord-injury/cauda-equina-syndrome]
• Spinal cord injury: Direct trauma to the spinal cord from excessive force — causing paralysis, sensory loss, or permanent neurological damage. [Link to: /spinal-cord-injury/lawyer]
• Vertebral fracture: Chiropractic adjustment of patients with osteoporosis or spinal tumors can cause vertebral fractures.
• Rib fractures: Thoracic manipulation can fracture ribs — particularly in elderly or osteoporotic patients.
• Aggravation of underlying conditions: Chiropractic treatment of patients with undiagnosed spinal cord compression, tumors, infections, or inflammatory conditions (like ankylosing spondylitis) can cause catastrophic harm.
• Stroke from carotid artery dissection: Less common than vertebral artery dissection — but can occur from anterior neck manipulation.

The Standard of Care for Chiropractors

The standard of care for chiropractors in New York is established by the New York State Board for Chiropractic, the American Chiropractic Association (ACA), and peer-reviewed chiropractic literature. Key elements include:

1. Thorough history and examination: Before performing any spinal manipulation, the chiropractor must take a thorough medical history and perform a comprehensive physical and neurological examination — including assessment for red flags.

2. Screening for VAD risk factors: The standard of care requires screening for risk factors that contraindicate cervical manipulation — including: - History of stroke or TIA (transient ischemic attack) - Connective tissue disorders (Ehlers-Danlos syndrome, Marfan syndrome, fibromuscular dysplasia) - Severe or sudden-onset headache (possible dissection already in progress) - Neurological symptoms (dizziness, visual changes, weakness) - Recent head or neck trauma - High blood pressure - Use of anticoagulant medications

3. Appropriate imaging: Ordering cervical spine X-rays or MRI when indicated — particularly for patients with a history of trauma, suspected fracture, or neurological symptoms.

4. Informed consent: Adequately explaining the risks of cervical manipulation — including the risk of vertebral artery dissection and stroke. Failure to obtain informed consent is a common breach. [Link to: /surgical-errors/informed-consent]

5. Proper technique: Using appropriate force, staying within the normal range of motion, and avoiding excessive rotational thrusts — particularly at the C1-C2 level.

6. Recognizing complications: Recognizing the signs of VAD, neurological injury, or other complications — and immediately referring for emergency evaluation.

7. Avoiding contraindicated procedures: Not performing cervical manipulation on patients with clear contraindications — and using alternative treatments (such as mobilization, soft tissue techniques, or exercise therapy) for high-risk patients.

When a Chiropractic Injury Constitutes Malpractice

A chiropractic injury constitutes malpractice when:

- The chiropractor failed to screen for risk factors — particularly VAD risk factors before performing cervical manipulation. - The chiropractor performed cervical manipulation on a patient with clear contraindications — such as a history of stroke, connective tissue disorder, or neurological symptoms. - The chiropractor used excessive force or improper technique — particularly excessive rotational thrusts at C1-C2. - The chiropractor failed to obtain informed consent — not adequately explaining the risk of vertebral artery dissection and stroke. [Link to: /surgical-errors/informed-consent] - The chiropractor failed to recognize the signs of VAD — and did not immediately refer the patient for emergency neurological evaluation. - The chiropractor continued treatment despite new neurological symptoms — worsening the injury. - The chiropractor manipulated a patient with an undiagnosed condition — such as spinal cord compression, fracture, or tumor — causing catastrophic harm.

To prove malpractice, expert testimony from a qualified chiropractor — and often a neurologist or neurosurgeon — is required under CPLR § 3012-a.

Proving Causation in Chiropractic Stroke Cases

Proving that chiropractic manipulation caused a vertebral artery dissection and stroke requires establishing:

1. The manipulation occurred: Documentation that the patient received cervical spine manipulation — including the specific technique used and the spinal levels adjusted.

2. The VAD occurred after the manipulation: Medical records establishing the timeline — with the onset of symptoms after the adjustment.

3. The manipulation caused the dissection: Expert testimony from a vascular neurologist or interventional neuroradiologist — linking the cervical manipulation to the vertebral artery dissection based on: - The location of the dissection (C1-C2 is the most common site of manipulation-related VAD) - The timeline (symptoms developing within hours to days of the adjustment) - The absence of other causes (no trauma, no underlying connective tissue disorder, no spontaneous dissection)

4. The standard of care was breached: Expert testimony that the chiropractor failed to screen for risk factors, failed to obtain informed consent, used improper technique, or failed to recognize complications.

The defense may argue that the VAD was spontaneous — that the patient had a pre-existing dissection that caused the neck pain (leading them to seek chiropractic care) — or that the manipulation was not the cause. Expert testimony is required to distinguish manipulation-induced VAD from spontaneous VAD — and to establish the causal link. [Link to: /medical-malpractice/stroke-misdiagnosis]

New York Statute of Limitations

Chiropractic malpractice in New York is governed by the same statute of limitations as medical malpractice — 2.5 years from the date of the negligent act (CPLR § 214-a). For wrongful death (if the patient died from the stroke), the deadline is 2 years from the date of death (EPTL § 5-4.1). The continuous treatment doctrine may extend the deadline if you continued receiving chiropractic treatment from the same provider for the same condition. Contact a chiropractic malpractice attorney as early as possible — these cases are medically complex and require time to build. [Link to: /medication-errors/statute-of-limitations] [Link to: /wrongful-death/statute-of-limitations]

Frequently Asked Questions

The value of a medical malpractice case in New York depends on several factors, including the severity of the injury, the strength of liability evidence, and the economic and non-economic damages involved. New York is one of the few states with no caps on medical malpractice damages, meaning there is no artificial limit on what you can recover. Below are typical settlement ranges based on injury severity.