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Concludes that serious cerebrovascular complications of spinal manipulation continue to be reported. Their incidence is unknown. Large and rigorous prospective studies are necessary in order to define the risks of spinal manipulation accurately. E. Ernst, Physical Therapy Reviews (March 2004) [The Full Text version of this article has recently become subscription-only. In the Case Reports section (Table 1) of the Full Text version, 11 cases are listed where a chiropractor was the therapist involved in administering cervical spine manipulation in which the CAUSALITY of the adverse event is listed as 'CERTAIN'. In two of these cases (Corazzo 1998 and Siegel 2001), the adverse event was vertebral artery dissection and stroke].