Manipulation in the Presence of Cervical Spinal Cord Compression: A Case Series

Murphy, Donald R.; Hurwitz, Eric L.; Gregory, Amy A.

doi:10.1016/j.jmpt.2006.01.001

Cited by 24 publications

(20 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Spinal manipulation, particularly performed on the upper spine, is known to be associated with mild to severe complications [6,11,15,16]. The literature reviewed by Patjin in 1991 showed a complication rate of 1 in 518,886 procedures.…”

Section: Discussionmentioning

confidence: 99%

Acute paraplegia after chiropraxis

López-González

Peris-Celda

2010

Eur Spine J

View full text Add to dashboard Cite

Spinal manipulation is a form of back and other musculoskeletal pain treatment that often involves a highvelocity thrust, a technique in which the joints are adjusted rapidly. The main objective of chiropractors is to correct spinal malalignment and relieve the nerves, allowing them to function optimally (Ernst In: Expert Rev Neurother 7:1451-1452 Oppenheim et al. In: Spine J 5:660-666, 2005 16-25, 2007; Thiel et al. In: Spine 32: 2375-2378. Several case reports and series have been focusing on the risks of chiropraxis, especially on the cervical spine, although the risk/benefit ratio for certain selected patients could be acceptable (Powell et al.In: Neurosurgery 33:73-78, 1993). We describe the case of a 45-year-old woman who suffered complete paraplegia shortly after a chiropractic maneuver in the thoracic spine. Dorsal CT showed a calcified disc herniation at the T8-T9 level and MRI revealed a diffuse spinal cord ischemia from T6 to the conus medullaris without spinal cord compression at the level of herniation. Despite a normal arteriography, authors suggest a vascular injury as the cause of the deficit.Keywords Chiropraxis Á Spinal cord ischemia Á Acute paraplegia Á Herniated disc Clinical caseA 45-year-old woman was admitted to the Neurosurgery Department of our hospital with the diagnosis of traumatic thoracic disc herniation and complete paraplegia of 12 h of evolution. She was first attended to in another hospital and then urgently sent to our department.When the patient arrived at the emergency room, she had grade 0/5 motor strength in both the lower extremities, abolished deep tendon reflexes and complete sensory loss below the T8-T9 level. She had previously refused NASCIS protocol, which was offered at the first hospital, but she finally accepted it after being admitted to our department.She had a history of only diffuse, not irradiated middle and low back pain and was being treated with chiropractic sessions for 2 years. On the day of onset of her paraplegia, she went to one of those sessions and suffered an unusual but temporary thoracic pain when the chiropractor was manipulating her middle thoracic zone. Approximately 20 min after the end of the session, she felt proximal weakness in her lower extremities, and the symptoms of a complete paraplegia and spine cord shock were progressively established within a 1-2-h period.The blood and urinary analyses, including C-reactive protein levels and the globular sedimentation rate, were normal and the body temperature was 36.5°C.A magnetic resonance imaging (MRI) performed at the hospital of origin 5 h after the beginning of the weakness showed two anomalies: one disc herniation (T8-T9) (Fig. 1a) and hypersignal under the T9 level in a T2A. Lopez-Gonzalez and M. Peris-Celda contributed equally.

show abstract

Section: Discussionmentioning

confidence: 99%

Acute paraplegia after chiropraxis

López-González

Peris-Celda

2010

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…13 Although surgery remains one treatment option, various authors have suggested nonsurgical approaches, including cervical traction, 11,[13][14][15][16][17] and manual therapies, including HVLA manipulation, among others. 10,[18][19][20] The efficacy and safety of HVLA in the treatment of these patients are still controversial, and there are reported cases in the literature of serious sequelae from cervical spine manipulation. 10 The present report describes a patient with documented cervical disk herniation and radicular findings who was deemed a surgical case by 2 respected neurosurgeons.…”

Section: Discussionmentioning

confidence: 99%

“…10,[18][19][20] The efficacy and safety of HVLA in the treatment of these patients are still controversial, and there are reported cases in the literature of serious sequelae from cervical spine manipulation. 10 The present report describes a patient with documented cervical disk herniation and radicular findings who was deemed a surgical case by 2 respected neurosurgeons. Her reflex and motor strength loss was fairly subtle, although her sensory symptoms were fairly persistent.…”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that the benefits of chiropractic care outweighed the risks. 9 Murphy et al 10 recently reported on a series of 27 patients with cervical cord compression. They noted that the role of CMT in the treatment of radiculopathy was unclear and cited authors who felt that CMT was contraindicated in such patients based in part on reports of purported complications from the treatment.…”

Section: Introductionmentioning

confidence: 99%

“…He advocated using a provocative "premanipulative position" before manipulation, moving slowly to the "restrictive barrier"; and if "peripheralization" of symptoms is noted, another direction of manipulation is sought. 10 Cervical radiculopathy has been defined as an abnormality of a nerve root that originates in the cervical spine 11 resulting from compression and inflammation of nerve root or roots in proximity to the neuroforamen. 12 It has an annual incidence of approximately 85 per 100 000, 11,12 is more common in men than women, and has a peak incidence in the sixth decade of life.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Resolution of cervical radiculopathy in a woman after chiropractic manipulation

Whalen¹

2008

Journal of Chiropractic Medicine

View full text Add to dashboard Cite

Objective: To describe a case regarding a woman with 2-level cervical disk herniation with radicular symptoms conservatively treated with chiropractic care including high-velocity, lowamplitude (HVLA) manipulation with complete resolution of her symptoms. Clinical Features: A 40-year-old woman developed right finger paresthesia and neck pain. Results of electrodiagnostics were normal, but clinical examination revealed subtle findings of cervical radiculopathy. A subsequent magnetic resonance imaging revealed a large right posterolateral disk protrusion and spur impinging on the right hemicord with moderate to severe central canal and right neuroforaminal stenosis at C5-6 and C6-7. She was treated with HVLA manipulation to the cervical spine, as well as soft tissue techniques, traction, nonsteroidal anti-inflammatory drugs, and exercise. Intervention and Outcome: Her clinical findings and symptoms resolved within 90 days of initiating care and did not return in 1 year. There were no untoward effects, including transient ones. Conclusion: This case describes the clinical presentation and course of a patient with multilevel large herniated disks and associated radiculopathy who was treated with HVLA manipulation and other conservative approaches and appeared to have good outcomes.

show abstract

Anwendbarkeit und klinische Relevanz randomisierter kontrollierter Studien

Zwack¹

2006

Manuelle Medizin

View full text Add to dashboard Cite

Manipulation in the Presence of Cervical Spinal Cord Compression: A Case Series

Cited by 24 publications

References 33 publications

Acute paraplegia after chiropraxis

Acute paraplegia after chiropraxis

Resolution of cervical radiculopathy in a woman after chiropractic manipulation

Anwendbarkeit und klinische Relevanz randomisierter kontrollierter Studien

Contact Info

Product

Resources

About