Case Report Quadriplegia Following Chiropractic Manipulation

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Case Report Quadriplegia Following Chiropractic Manipulation
J.Neurol.Sci.[Turk]
Journal of Neurological Sciences [Turkish] 29:(3)# 32; 631-634, 2012
http://www.jns.dergisi.org/text.php3?id=586
Case Report
Quadriplegia Following Chiropractic Manipulation
Veli ÇITIŞLI, Nevhis AKINTÜRK, Hasan KANYILMAZ, Sedat ÇAĞLI, Mehmet ZİLELİ
Ege Üniversitesi, Nöroşirürji AD, İzmir
Summary
Chiropractic manipulation is considered as a way of treatment for patients who have neck
pain without any neurological symptoms. However complications of spinal manipulation are
usually underestimated and could be dangerous especially when performed by non-trained
personnel. Following the sudden onset of spinal manipulation, massage this paper, we
identified 33 year-old man presented a case of quadriplegia C8.MRI scans showed cervical
stenosis with C6-T1 right para central disc herniation.
Key words: Chiropractic manipulation,quadriplegia,C6-T1 paracentral disc herniation
Omurga Masajı Manipülasyonunu Takiben Quadripleji Gelişmesi
Özet
Omurga masajı ile manipülasyon, herhangi bir nörolojik belirtiler olmadan boyun ağrısı olan
hastalar için tedavi yolu olarak kabul edilir. Ancak spinal manipülasyonun komplikasyonları
genellikle göz ardı edilir ve özellikle eğitimli olmayan kişiler tarafından gerçekleştirildiği
zaman tehlikeli olabilir. Bu yazıda biz omurga masajı manipülasyonunu takiben ani başlayan
C8 kuadripleji saptanan 33 yaşında erkek bir olguyu sunduk. MRI taramaları ile C6-T1 sağ
parasantal disk herniasyonu ile servikal stenoz gösterdi.
Anahtar Kelimeler: Quadripleji,servikal parasantral disk,omurga masajı ile manipülayon
onset of quadriplegia following cervical
spinal manipulation due to disc herniation.
INTRODUCTION
Neck pain is a common illness seen
throughout the world(1). Its lifetime
prevalence is found to be 67%(2).
Chiropractic manipulation is an alternative
way of treatment technique widely used for
mechanical
disorders
of
the
musculoskeletal system in the world.
Throughout the literature stroke, basilar
and vertebral artery trauma, spinal epidural
hematoma, herniated nucleus pulposus
have been reported as well as minor
complications such as pain, discomfort,
dizziness(5,9). These complications are
usually underestimated and may cause
even death especially when performed by
non educated personnel. We report sudden
CASE PRESENTATION
33-year old male was admitted to our
hospital emergency room with sudden
onset of quadriplegia. He had told that he
had flue 1 week before and also severe
neck pain. His neurological exam showed
he had C8 quadriplegia with no anal reflex.
He was diagnosed transverse myelitis and
was given intravenous prednisolone
therapy. In the first 24 hours of admission
to the hospital, MRI scan showed C 6-7-T1
disc herniation with cervical stenosis
(Figure). He was immediately taken into
surgery where anterior discectomy (C6-7)
with fusion was performed. After the
surgery his neurological examination was
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J.Neurol.Sci.[Turk]
the same, C8 quadriplegia, no anal reflex.
One week later, second operation was
performed posteriorly, C3-7 spinal
enstrumantation with decompression. Later
on, he confessed that he had undergone
cervical spinal manipulation on the day of
quadriplegia. He was transferred to a
rehabilitation clinic after discharge.
Figure 1: Preop MRG appearance
632
J.Neurol.Sci.[Turk]
Figure 2: Postop MRG appearance
Figure 3: Postop X-Ray
633
J.Neurol.Sci.[Turk]
REFERENCES
DISCUSSION
Since neck pain is widely seen in the
world, as reported by Shekelle, 18 million
people gets treatment by chiropractors each
year due to this disorder(8). Many adverse
effects are seen after chiropractic and most
of them are negligible and short lasting(7).
According to many studies, patients are
relieved from neck pain after spinal
manipulation(6,4). However incidence of
severe neurological complications are
found to be 1 in 5 million after cervical
neck manipulations(3). Spinal hematomas,
disc herniation, stroke are the most
common complications. Patient selection,
correct diagnosis and trained chiropractors
are important factors for decreasing the
severe neurological complications.
1.
2.
3.
4.
5.
6.
7.
Correspondence to:
Veli Çıtışlı
E-mail: [email protected]
8.
9.
Received by: 21 February 2012
Revised by: 26 May 2012
Accepted: 28 May 2012
The Online Journal of Neurological
Sciences (Turkish) 1984-2012
This e-journal is run by Ege University
Faculty of Medicine,
Dept. of Neurological Surgery, Bornova,
Izmir-35100TR
as part of the Ege Neurological Surgery
World Wide Web service.
Comments and feedback:
E-mail: [email protected]
URL: http://www.jns.dergisi.org
Journal of Neurological Sciences (Turkish)
Abbr: J. Neurol. Sci.[Turk]
ISSNe 1302-1664
634
Bovin G, Schrader H, Sand T: Neck pain in the
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Cote P, Cassidy JD, Corroll L: The Saskatchewan
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Gross AR, Hoving JL, Haines TA, et al; Cervical
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K: Catastropic Complication of Chiropractic
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American journal of Medicine 122(11):e3-4, 2009

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