RESEARCH - Complications of cervical spine manipulation therapy

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Complications of Cervical Spine Manipulation Therapy: 5-Year

Retrospective Study in a Single-Group Practice

from Neurosurgical Focus

Posted 01/24/2003

G. Malone, M.D., Nevan G. Baldwin, M.D., J. Tomecek, M.D.,

M. Boxell, M.D., E. Gaede, M.D., G.

Covington, M.D., Kenyon K. Kugler, M.D.

Abstract and Introduction

Abstract

Object: The authors report a series of 22 patients in whom major

complications developed after cervical spinal manipulation therapy

(CSMT). A second objective was to estimate the regional incidence of

these complications and to compare it with the very low incidences

reported in the literature.

Methods: During a 5-year period, practioners at a single group

neurosurgical practice in Tulsa, Oklahoma, treated 22 patients, who

were markedly worse during, or immediately after, CSMT. The details of

these cases are reported. The 1995 US Government National Census was

used to define the regional referral population for Tulsa. The

published data regarding the incidence of serious CSMT-related

complications and the rate of CSMTs undertaken nationally were used to

estimate the expected number of CSMT-related complications in the

authors' region. The number (22 cases) reported in this series was

used to estimate the actual regional incidence.

Complications in the series included radiculopathy (21 cases),

myelopathy (11 cases), Brown-Séquard syndrome (two cases), and

vertebral artery (VA) occlusion (one case). Twenty-one patients

underwent surgery. Poor outcomes were observed in three, outcome was

unchanged in one, and 17 improved. The number of patients in this

series exceeded the expected number for the region.

Conclusions: Cervical spinal manipulation therapy may worsen

preexisting cervical disc herniation or cause disc herniation

resulting in radiculopathy, myelopathy, or VA compression. In cases of

cervical spondylosis, CSMT may also worsen preexisting myelopathy or

radiculopathy. Manipulation of the cervical spine may also be

associated with higher complication rates than previously reported.

Excerpt:

Contraindications to Cervical Spine Manipulation

High-velocity neck manipulation is absolutely contraindicated in

patients with rheumatoid arthritis, acute fractures and dislocations,

os odontoideum, infection of bone, osseous malignancies, or cervical

myelopathy. Cervical spine manipulation is relatively to absolutely

contraindicated in patients with benign bone tumors, vertebrobasilar

insufficiency, and aneurysm of a major blood vessel. Neck manipulation

is relatively contraindicated in cases of joint hypermobility,

postsurgical joints, and osteoporosis.[51,13] Manipulation of the

cervical spine in the acute phases of cervical disc herniation in

cases associated with deficit is contraindicated until the deficit has

resolved.[51,13] Dvorak, et al.,[13] have written the following: " In

the acute phase of cervical disc herniation with neurologic deficit,

manipulation and mobilization of the affected segments are

contraindicated as there is a high risk of spinal cord compression due

to massive prolapse. " In cases of traumatic cervical dislocation,

manipulation and reduction of the dislocation has in some cases led to

neurological deterioration due to disc displacement into the spinal

canal, resulting in cord compression.[30]

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