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Myelopathy following cervical spine manipulation

L S Kewalramani, D L Kewalramani, M Krebs

American Journal of Physical Medicine

|August 1, 1982

Summary

Cervical spine manipulation can lead to serious spinal cord injury (myelopathy), causing severe neurological deficits. This study presents three cases of myelopathy following manipulation, highlighting the risks associated with this procedure.

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Area of Science:

Neurology
Orthopedics
Physical Therapy

Background:

Spinal manipulation is a widely practiced but controversial mechanotherapeutic procedure.
While arterial occlusion from neck manipulation is documented, cervical myelopathy is less referenced.

Observation:

Three patients developed cervical myelopathy after spinal manipulation, presenting with increased pain and rapid neurological decline.
All patients experienced significant sensory/motor deficits within 24 hours, progressing to tetraparesis.

Findings:

Two patients had vertebral fractures (C5, C6); myelography revealed spinal cord widening and partial blocks in all.
Pathological findings included hematomyelia and spinal cord edema/hyperemia.
Surgical interventions included vertebral body excision, fusion, and laminectomy.

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Implications:

Cervical spine manipulation poses a risk of severe neurological injury, including myelopathy and vertebral fracture.
Prompt diagnosis and surgical intervention are crucial for managing post-manipulation myelopathy.
Further research is needed to understand the mechanisms and risk factors for cervical manipulation-induced myelopathy.