Brown-Se´quard Syndrome of the Cervical Spinal Cord after Chiropractic Manipulation

AJNR Am J Neuroradiol, 1998 · DOI: · Published: August 1, 1998

Alternative Medicine Neurology Medical Imaging

Simple Explanation

A 58-year-old woman experienced weakness and sensory changes after chiropractic neck manipulations. These symptoms were diagnosed as Brown-Se´quard syndrome, a condition resulting from damage to one side of the spinal cord. MR imaging revealed swelling and increased signal intensity in the left side of the spinal cord at the C4 level, consistent with a contusion. The patient was treated with immobilization and steroids, followed by physical therapy. The patient showed improvement in strength after physical therapy, but some sensory deficits persisted. The case highlights a rare complication of chiropractic manipulation and the importance of considering underlying conditions.

Study Duration

Not specified

Participants

One 58-year-old woman

Evidence Level

Level 4, Case Report

Key Findings

1
The patient presented with clinical features consistent with Brown-Se´quard syndrome following chiropractic manipulation.
2
MR imaging revealed increased signal in the left hemicord at the C4 level, suggestive of contusion.
3
The patient's symptoms stabilized with immobilization and steroids, and she regained strength with physical therapy, although some sensory deficits remained.

Research Summary

This case report describes a 58-year-old woman who developed Brown-Se´quard syndrome after undergoing chiropractic manipulation for neck and thoracic pain. The patient experienced left-sided weakness and right-sided sensory loss. MR imaging revealed a contusion in the left hemicord at the C4 level. The patient was treated with steroids and physical therapy, which led to improvement in strength, but residual sensory deficits persisted. The authors hypothesize that the patient's underlying spondylosis may have predisposed her to this injury during the chiropractic manipulation, particularly the high-velocity thrust technique.

Practical Implications

Risk Awareness

Clinicians should be aware of the potential, though rare, for chiropractic manipulation to cause spinal cord injury, especially in patients with pre-existing spinal conditions.

Careful Patient Screening

Thorough patient screening and consideration of contraindications to chiropractic therapy, such as bony abnormalities or myelopathy, are crucial to minimizing risk.

Informed Consent

Patients should be informed of the potential risks associated with chiropractic manipulation, including the possibility of neurological complications.

Study Limitations

1
Single case report limits generalizability.
2
Patient's pre-existing spondylosis complicates determination of direct causality.
3
Lack of a second follow-up MR limits assessment of long-term cord changes.

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