Objective: The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death. Design: This study is a systematic review of case reports. Methods: Literature searches in four electronic databases with no restrictions of time or language. Main outcome measure: Death. Results: Twenty six fatalities were published in the medical literature and many more might have remained unpublished. The alleged pathology usually was a vascular accident involving the dissection of a vertebral artery. Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.