The Noord-Holland Court has passed its judgment in relation to a chiropractor alleged to have caused serious physical injury after a patient, who had presented with a 5-day history of head and neck pain, and who became unwell during a second treatment session involving spinal manipulative therapy (SMT) on January 26, 2016, at his practice in Haarlem. He lost consciousness, was resuscitated, and taken to hospital by ambulance.

At the hospital, it was determined that the patient had suffered a brainstem infarction due to oxygen deficiency as a result of vertebral artery dissection. The patient developed various neurological deficits, including paralysis of the limbs, speech disorders, and visual disturbances. Over time, some function has returned, but the patient remains severely limited by the neurological deficits and to a large extent is dependent on care.

Experts investigated whether the injury was caused by the SMT. Experts reported that there are several possible causes for a dissection of the vertebral artery but concluded that there is no scientific evidence to support a causal relationship between SMT and the occurrence of a dissection. No clear cause of the patient’s dissection was established.

The Court also took note of a neurologist’s report, produced on the instruction of the liability insurer. The neurologist stated that the dissections were caused by SMT of the neck, a view rejected by the Court on the basis that he was unable to substantiate his opinion.

The Court ruled that it had not been legally and convincingly proved that it is the fault of the chiropractor that the patient suffered serious physical injuries during treatment in January 2016. In light of the experts’ conclusions, the Court found it could not establish beyond reasonable doubt that the dissection was the result of treatment performed by the chiropractor.

The Court determined that the chiropractor adhered to the professional standards of the Netherlands Chiropractors Association. It considered that, prior to the treatment, he took sufficient steps to identify possible contraindications to cervical SMT. In the absence of such contraindications, the Court found there was no reason for the chiropractor to forgo the treatment.

The Court ruled that the chiropractor did not have to inform the patient that dissection would be a possible risk of the treatment. The experts’ reports indicate that the current state of knowledge cannot identify vertebral artery dissection as a potential risk of cervical SMT. Moreover, a dissection of the vertebral artery after neck manipulation (resulting in a brainstem infarction) is very rare.