Spinal epidural hematoma after spinal manipulative therapy in a patient undergoing anticoagulant therapy: a case report.
OBJECTIVE
We report on the case of a patient with spinal epidural hematoma (SEH) after spinal manipulative therapy and review features of reported cases of a similar nature.


METHODS
The patient was undergoing Coumadin anticoagulant therapy for atrial fibrillation and presented to the chiropractor complaining of a stiff neck. After cervical manipulation, he developed paresthesia in both feet, progressing to motor deficits in all 4 extremities. He required a laminectomy and evacuation of a clot indenting the spinal cord.


RESULTS
Review of the literature revealed 7 reported cases of SEH after manipulation; 5 patients underwent cervical manipulation and 1 patient received Coumadin therapy.


CONCLUSIONS
Practitioners of spinal manipulative therapy should be aware of SEH as a possible complication of manipulation in patients at risk and should exercise caution in the care of patients undergoing anticoagulant therapy.
Whedon
James M
JM
Trauma Program, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. james.m.whedon@hitchcock.org
Quebada
Patricia B
PB
Roberts
David W
DW
Radwan
Tarek A
TA
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy; D006333:Heart Failure / Q000188:drug therapy; D046748:Hematoma, Epidural, Spinal / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000009:adverse effects*
D000925:Anticoagulants