WEBINAR – ARTICLE FOCUS

Cervical artery dissection
Decision tree proposal
For use by manual therapists.

Tuesday June 24, 2025 – from 12 p.m. to 1 p.m.

by Stéphane Kaczorowski (Scientific collaborator in the osteopathy sector of the HEdS-FR)
The article will be put into perspective by Pierre Balthazard, Lecturer in the physiotherapy sector at HESAV, and the debate will be moderated by Claude Pichonnaz, Dean of the physiotherapy sector at HESAV.

Summary

Introduction: Cervical artery dissections are the most feared adverse events during cervical manual therapies. Their incidence has probably been underestimated for a long time and amounts to 8.93/100,000 inhabitants/year (95% CI, 6.53–11.34). Their clinical presentation varies greatly, which can notably take the form of neck pain with a mechanical appearance or a headache with a cervicogenic appearance, leading to a risk of an apparent incorrect indication for manual cervical treatment. Existing standardized decision trees do not allow safe practice in the face of this phenomenon. A new tree adapting to the complexity of clinical reasoning is therefore proposed.

Development: the proposed decision tree is based on the clinical presentation and the patient’s preferences collected during the history as well as the cardiovascular and neurological clinical examinations carried out. Six scenarios are described with their practical implications, from emergency reorientation to conditional care and monitoring of progress.

Discussion: Faced with the diagnostic challenge posed by this problem, no certainty can be established. It is therefore preferable to adopt a cautious approach, taking into account the patient’s values.

Conclusion: this decision tree could contribute to the safe management of patients presenting with neck pain or headache, and following the principles of evidence-based practice by including the best current data available. A study focusing on its psychometric properties would be relevant to test this hypothesis.

All information on this page comes from the Mains Libres website