The link between neck manipulation and dissection is challenging to accurately gauge because the majority of cited literature relies on case reports or retrospective case series which are heavily prone to under reporting and bias. Chiro organizations are also highly incentivized to downplay the incidence for business and malpractice reasons.
Regardless, I think the bigger concern about Chiro neck manipulation is the misdiagnosis -> mistreatment aspect. Anecdotally, we always see a couple cases per year of vertebral artery dissections that were initially treated by Chiros for "neck pain", where the patient did not present to the ER until after they progressed to a stroke. I don't think the Chiros caused the majority of these dissections to be honest, but they certainly delayed proper diagnosis and potential treatment which could have prevented a debilitating outcome.
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