Spinal Epidural Hematoma After Spinal Manipulative Therapy in a Patient Undergoing Anticoagulant Therapy: A Case Report
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.
aTrauma Registrar, Trauma Program, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Private Practice of Chiropractic, Grantham, NH
bResident, Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
cSection Chief, Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
dResident, Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
Submit requests for reprints to: James M. Whedon, DC, Trauma Registrar, Trauma Program, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756.
ABSTRACT