• Cooper J
• Battaglia P
• Reiter T

• Adult
• Affiliation / Baylor Scott and White Health. Department of Chiropractic Medicine
• Affiliation / Logan University. College of Chiropractic
• Affiliation / Novant Health Forsyth Medical Center. Department of Physical Medicine and Rehabilitation
• Affiliation(G) / United States / Missouri / Chesterfield
• Affiliation(G) / United States / North Carolina / Winston-Salem
• Affiliation(G) / United States / Texas / Round Rock
• Anticoagulants / therapeutic use
• Hematoma, Epidural, Spinal / etiology
• Male
• Manipulation, Cervical / adverse effects
• Open Access Document

Background: Spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. To the best of our knowledge, we present the first case of a patient with an iatrogenic hypercoaguable state performing self-neck manipulation, which resulted in a spinal epidural hematoma and subsequent quadriparesis.

Case presentation: A 63-year-old man presented to the emergency department with worsening interscapular pain radiating to his neck 1 day after performing self-manipulation of his cervical spine. He was found to be coagulopathic upon admission, secondary to chronic warfarin therapy for the management of atrial fibrillation. Approximately 48 h after the manipulation, the patient became acutely quadriparetic and hypotensive. Urgent magnetic resonance imaging revealed a multilevel spinal epidural hematoma from the lower cervical to thoracic spine.

Conclusions: Partial C7, complete T1 and T2, and partial T3 bilateral laminectomy was performed for evacuation of the spinal epidural hematoma. Following a 2-week course of acute inpatient rehabilitation, the patient returned to his baseline functional status. This case highlights the risks of self-manipulation of the neck and potentially other activities that significantly stretch or apply torque to the cervical spine. It also presents a clinical scenario in which practitioners of spinal manipulation therapy should be aware of patients undergoing anticoagulation therapy.

Author keywords: Spinal epidural hematoma — Spinal manipulation — Anticoagulants

Author affiliations: JC: Department of Chiropractic Medicine, Baylor Scott and White Health, Round Rock, Texas, United States; PB: Department of Chiropractic, Logan University, Chesterfield, Missouri, United States; TR: Department of Physical Medicine and Rehabilitation, Novant Health Forsyth Medical Center, Winston-Salem, North Carolina, United States

This abstract is reproduced with the permission of the publisher; click on the above link for free full text. PubMed Record