Nonvascular complications following spinal manipulation.
BACKGROUND
Spinal manipulation is associated with various vascular and nonvascular complications. Most prior studies have focused on the vascular complications.


OBJECTIVE
The purpose of this study is to better clarify the spectrum of nonvascular complications following spinal manipulation, and to help define the risks of manipulative treatment.


METHODS
Review of medical records and radiographic studies of appropriate subjects.


METHODS
Patients presenting to a neurosurgical practice over a 6-year period who suffered a qualitative worsening of symptoms immediately after spinal manipulative treatment.


METHODS
Neurological conditions were compared pre-manipulation, post-manipulation, and post-surgery.


METHODS
Record review of 18 patients.


RESULTS
Eighteen patients were identified who had received spinal manipulation and whose neurological condition immediately worsened. Injuries were sustained to the cervical, thoracic, and lumbar spine and resulted, variously, in myelopathy, paraparesis, cauda equina syndrome, and radiculopathy. Eighty-nine percent required surgery. Outcome was excellent in 50% and good in 37.5%. Three patients died from unrecognized malignancies.


CONCLUSIONS
Spinal manipulation can be associated with significant complications, often requiring surgical intervention. Pretreatment scanning may help identify patients with significant risk factors, such as substantial disc herniations or occult malignancies. Prompt evaluation and intervention is necessary when symptoms worsen or neurological deficits develop.
Oppenheim
Jeffrey S
JS
Section of Neurosurgery, Good Samaritan Hospital, 255 Lafayette Avenue, Suffern, NY 10901, USA. JOPPENHEIM@mac.com
Spitzer
Daniel E
DE
Segal
David H
DH
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000009:adverse effects*; D008875:Middle Aged; D011843:Radiculopathy / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013118:Spinal Cord Diseases / Q000175:diagnosis / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology