Acute paraplegia after chiropraxis

Abstract

Spinal manipulation is a form of back and other musculoskeletal pain treatment that often involves a high-velocity thrust, a technique in which the joints are adjusted rapidly. The main objective of chiropractors is to correct spinal malalignment and relieve the nerves, allowing them to function optimally (Ernst In: Expert Rev Neurother 7:1451-1452, 2007; Oppenheim et al. In: Spine J 5:660-666, 2005). The evidence for the effectiveness of this treatment based on randomized clinical trials still remains uncertain (Cassidy et al. In: Spine 33(4 suppl): S176-S183, 2008; Dupeyron et al. In: Ann Readapt Med Phys 46:33-40, 2003; Ernst et al. In: Expert Rev Neurother 7:1451-1452, 2007; Hurwitz et al. In: J Manipulative Physiol Ther 27:16-25, 2007; Thiel et al. In: Spine 32: 2375-2378, 2007). Several case reports and series have been focusing on the risks of chiropraxis, especially on the cervical spine, although the risk/benefit ratio for certain selected patients could be acceptable (Powell et al.In: Neurosurgery 33:73-78, 1993). We describe the case of a 45-year-old woman who suffered complete paraplegia shortly after a chiropractic maneuver in the thoracic spine. Dorsal CT showed a calcified disc herniation at the T8-T9 level and MRI revealed a diffuse spinal cord ischemia from T6 to the conus medullaris without spinal cord compression at the level of herniation. Despite a normal arteriography, authors suggest a vascular injury as the cause of the deficit.

Fig. 1

a. Saggital T1 MRI of the lumbar spine, performed 5 h after the beginning of the weakness, showing a herniated disc T8–T9 (arrow). b Saggital T2 MRI showing hypersignal under the T9 level (arrow)

Fig. 2

Axial CT scan showing a calcified thoracic T8–T9 foraminal hernia (arrow)

Fig. 3

Gradient-echo sequence MRI performed 16 h after the beginning of the weakness revealed small petechia in the conus medullaris (arrow)

Fig. 4

An MRI performed 15 days after the beginning of the symptoms revealed a diffuse spinal cord ischemia from T6 to the conus medullaris (arrows)