Shunt fracture as a sequela of cervical spine manipulation: a case report

Shunt disconnection is an unreported complication of spinal mobilization and manipulation. We present the case of a young adult who underwent cystoperitoneal (CP) shunt placement for an arachnoid cyst at the age of 6 years. The shunt remained functional during a follow-up period of 11 years. The patient was admitted with headache and diplopia that started after cervical manipulation by a chiropractor. Radiography revealed fracture of the distal catheter and resultant enlargement of the temporosylvian cyst. The patient required replacement of the disconnected tubing caudal to the shunt valve. The distal catheter ruptured immediately below the outlet connector of the valve. The symptoms and signs resolved completely after insertion of a new distal tube into the peritoneum. This case report demonstrates that chiropractic manipulation of the neck may be a cause of tubing breakage in patients with CP shunts.