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Secondary Spinal Cord Injury llI: Pathophysiology

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Early Ischemia and Ionic ImbalanceWithin minutes of spinal cord injury, a secondary cascade begins, progressing over hours to weeks. Vascular damage reduces blood flow, causing ischemia and mitochondrial dysfunction. ATP depletion leads to ion pump failure, membrane depolarization, sodium influx, potassium efflux, and water accumulation, resulting in cellular swelling. Increased intracellular calcium further disrupts mitochondria and accelerates cellular injury.Excitotoxicity and Neuronal...

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Updated: Jun 12, 2026

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Published on: November 8, 2024

Acute paraplegia after chiropraxis.

Antonio Lopez-Gonzalez¹, Maria Peris-Celda

¹Department of Neurosurgery, Hospital Universitario La Fe, avda. Campanar, 21, 46009 Valencia, Spain. anlopezgon@gmail.com

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society

|June 18, 2010

Summary

Spinal manipulation carries risks, including rare but severe outcomes like paraplegia. This case highlights a potential vascular injury following chiropractic treatment, emphasizing the need for careful patient selection and risk assessment.

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Last Updated: Jun 12, 2026

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Spinal Hernia Repair and Cauda Equina Repositioning After Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Published on: November 8, 2024

Area of Science:

Neurology and Musculoskeletal Medicine
Spinal Cord Injury Research
Diagnostic Imaging in Neurology

Background:

Spinal manipulation, a common treatment for musculoskeletal pain, involves high-velocity thrusts to correct spinal alignment and optimize nerve function.
The efficacy of spinal manipulation, particularly based on randomized clinical trials, remains a subject of ongoing scientific debate and uncertainty.
While generally considered safe for selected patients, case reports have documented risks associated with chiropractic procedures, especially concerning the cervical spine.

Observation:

A 45-year-old woman experienced complete paraplegia immediately after undergoing a chiropractic maneuver targeting the thoracic spine.
Diagnostic imaging, including dorsal CT and MRI, revealed a calcified disc herniation at the T8-T9 level and diffuse spinal cord ischemia from T6 to the conus medullaris.
Notably, there was no spinal cord compression at the herniation site, and arteriography results were normal.

Findings:

The patient's severe neurological deficit (paraplegia) and spinal cord ischemia occurred subsequent to thoracic spinal manipulation.
Despite the absence of direct compression and normal vascular imaging, the clinical presentation suggests a vascular injury as the likely cause of the spinal cord damage.
This case underscores a rare but critical adverse event associated with spinal manipulation.

Implications:

The findings necessitate a re-evaluation of the risk-benefit ratio of spinal manipulation, particularly in patients with potential underlying vascular or disc pathologies.
This case emphasizes the importance of thorough patient screening and diagnostic workups before and after chiropractic interventions to identify potential risks.
Further research into the mechanisms of vascular injury related to spinal manipulation is warranted to improve patient safety and treatment protocols.