Journal of Manipulative and Physiological Therapeutics
Volume 29, Issue 7 , Pages 582-585, September 2006

Spinal Epidural Hematoma After Spinal Manipulative Therapy in a Patient Undergoing Anticoagulant Therapy: A Case Report

  • James M. Whedon, DC

      Affiliations

    • Trauma Registrar, Trauma Program, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Private Practice of Chiropractic, Grantham, NH
    • Corresponding Author InformationSubmit requests for reprints to: James M. Whedon, DC, Trauma Registrar, Trauma Program, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756.
    • ,
  • Patricia B. Quebada, MD

      Affiliations

    • Resident, Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • ,
  • David W. Roberts, MD

      Affiliations

    • Section Chief, Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
    • ,
  • Tarek A. Radwan, MD

      Affiliations

    • Resident, Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Received 1 October 2005; received in revised form 8 November 2005; accepted 13 November 2005.

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.

Clinical Features

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.

Conclusion

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.

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PII: S0161-4754(06)00180-1

doi:10.1016/j.jmpt.2006.06.017

Journal of Manipulative and Physiological Therapeutics
Volume 29, Issue 7 , Pages 582-585, September 2006

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