title: Cervical intradural disc herniation after spinal manipulation therapy in a patient with ossification of posterior longitudinal ligament: a case report and review of the literature.
abstract: METHODS
  Case report and review of the literature.
  
  
  OBJECTIVE
  To report a patient presenting with Brown-Sequard syndrome due to cervical intradural disc herniation after spinal manipulation therapy.
  
  
  BACKGROUND
  Spinal manipulation therapy (SMT) is often used by people with neck pain or discomfort as an alternative therapy due to its claimed less invasiveness and comparable efficacy. However, excessive manipulations are reported to cause rare but serious complications such as tetraplegia, vertebral artery dissection, epidural hematoma, and phrenic nerve injury.
  
  
  METHODS
  Clinical history, physical examination, and radiographic findings of the patient were described. Anterior cervical discectomy at the C3/C4 level and interbody fusion with a Caspar plate-screw system for fixation, were performed.
  
  
  RESULTS
  A favorable surgical outcome was obtained. The Brown-Sequard syndrome improved and the patient regained full muscle power at a 3-months follow-up.
  
  
  CONCLUSIONS
  Cervical intradural disc herniation after SMT is rare and most often cause Brown-Sequard syndrome. Definite diagnosis and prompt surgery usually achieves a satisfactory outcome. Anterior discectomy with interbody fusion is recommended. The OPLL associated with degenerative disc reminds us of the increased risk of intradural disc herniation. Those high-risk groups should be more cautious with spinal manipulation therapy due to its serious sequelae.
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Change Gung University, Taoyuan, Taiwan, Republic of China.
authors.forename: Jung-Hao
authors.initials: JH
authors.lastname: Hsieh
authors.forename: Chieh-Tsai
authors.initials: CT
authors.lastname: Wu
authors.forename: Shih-Tseng
authors.initials: ST
authors.lastname: Lee
mesh_terms: D018437:Brown-Sequard Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D002574:Cervical Vertebrae; D017586:Diskectomy; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D020393:Manipulation, Spinal / Q000009:adverse effects*; D008875:Middle Aged; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications* / Q000000981:diagnostic imaging; D011859:Radiography; D013123:Spinal Fusion; D016896:Treatment Outcome