title: Spinal epidural hematoma after spinal manipulative therapy in a patient undergoing anticoagulant therapy: a case report.
abstract: 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.
authors.affiliation: Trauma Program, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. james.m.whedon@hitchcock.org
authors.forename: James M
authors.initials: JM
authors.lastname: Whedon
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Quebada
authors.forename: David W
authors.initials: DW
authors.lastname: Roberts
authors.forename: Tarek A
authors.initials: TA
authors.lastname: Radwan
mesh_terms: 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*
chemical_list: D000925:Anticoagulants