title: Herniated disc with radiculopathy following cervical manipulation: nonsurgical management.
abstract: BACKGROUND
  Spinal manipulation applied to the cervical spine is a relatively safe and effective treatment for neck pain and headache. However, complications of this form of treatment have been reported and these can at times be disabling and on rare occasions can be devastating. A postmanipulation complication being treated with a different form of manipulation has not previously been reported.
  
  
  OBJECTIVE
  To report a case of a patient who was treated with manipulation and who developed neck, scapular, and arm pain and arm numbness after the sixth visit, which was later attributed to three herniated discs. The patient was subsequently treated with a nonsurgical approach that included, but was not limited to, a different form of manipulation with apparent resolution of the problem.
  
  
  METHODS
  The patient was a 38-year-old banker who began seeing a chiropractic physician for treatment that included cervical manipulation. On the sixth visit, he developed pain immediately after treatment which became severe and was accompanied by numbness in his arm. He saw a neurosurgeon who recommended surgery, but was subsequently seen by a different chiropractic physician and was treated nonsurgically.
  
  
  METHODS
  The patient was found to have clinical signs of radiculopathy, including motor loss. Magnetic resonance imaging revealed disc herniations at C3-C4, C4-C5, and C5-C6.
  
  
  RESULTS
  The patient was treated by the author with an alternate approach that included non-high-velocity, low-amplitude manipulation and exercise with resolution of the problem.
  
  
  CONCLUSIONS
  This paper reports a case of a patient with radiculopathy secondary to multilevel disc herniations that appeared to be precipitated by cervical manipulation and who was treated nonsurgically with resolution of the problem. It is doubtful that the manipulation actually caused the disc herniations, but it is possible that it caused preexisting asymptomatic disc herniations to become symptomatic. Consideration should be given to nonsurgical referral of patients who have postmanipulative complications but do not need immediate surgery.
authors.affiliation: Rhode Island Spine Center, and Department of Community Health, Brown University School of Medicine, Providence, RI 02860, USA. rispine@aol.com
authors.forename: Donald R
authors.initials: DR
authors.lastname: Murphy
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000473:pathology; D007839:Functional Laterality; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000209:etiology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects*; D059408:Pain Management; D011843:Radiculopathy / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome