Cervical epidural hematoma after spinal manipulation therapy: a case report

BMC Musculoskeletal Disorders, 2019 · DOI: https://doi.org/10.1186/s12891-019-2871-y · Published: October 9, 2019

Alternative Medicine Trauma Research Methodology & Design

Simple Explanation

Cervical spinal manipulation, a common treatment for neck pain, carries potential risks like ligament damage and spinal cord injuries. Epidural hematoma, the accumulation of blood in the spine's epidural space, is rare after neck manipulation but can lead to serious complications. This case report details a patient who developed tetraplegia and spinal shock following neck manipulation. An MRI revealed an acute posterior epidural hematoma, requiring emergency surgery. The patient showed partial improvement post-surgery. The study underscores the importance of assessing patient history and risk factors before performing spinal manipulation. Early MRI diagnosis is crucial for suspected hematomas to guide appropriate treatment.

Study Duration

Not specified

Participants

A 55-year-old man

Evidence Level

Level 4: Case Report

Key Findings

1
A 55-year-old man developed tetraplegia and spinal shock after cervical spinal manipulation for stiff neck pain, with no prior history of coagulation disorders or anticoagulant use.
2
MRI revealed an acute posterior epidural hematoma from C3 to T3 vertebrae, leading to spinal stenosis, with the narrowest point at the C5-C6 levels.
3
Emergency hematoma removal resulted in partial improvement in symptoms of paralysis during follow-up, highlighting the potential for neurological recovery with timely intervention.

Research Summary

This case report presents a rare instance of cervical epidural hematoma and tetraplegia following spinal manipulation therapy in a 55-year-old male with no prior history of related conditions. The patient underwent emergency surgery to remove the hematoma, which resulted in some neurological improvement, emphasizing the need for prompt diagnosis and intervention. The authors highlight the importance of careful patient screening and risk assessment before performing cervical spinal manipulation to minimize the risk of severe complications.

Practical Implications

Enhanced Patient Screening

Thorough patient interviews and clinical assessments are crucial before performing cervical spine manipulation to identify potential risks.

Early MRI Diagnosis

In cases of suspected cervical epidural hematoma, early MRI scans are necessary to accurately determine the location and severity of the hematoma.

Cautious Manipulation

High-risk patients should be approached with caution, and cervical spinal manipulation may be prohibited to prevent severe complications.

Study Limitations

1
The case report is based on a single patient, limiting the generalizability of the findings.
2
The report notes the absence of detailed clinical characteristic descriptions (smoking, trauma, etc.) that may be risk factors.
3
Lack of specific details regarding the manipulation technique used.

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