Spinal epidural hematoma after spinal manipulative therapy in a patient undergoing anticoagulant therapy: a case report.

Abstract

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.

• Authors: James M Whedon, Patricia B Quebada, David W Roberts, Tarek A Radwan
• Journal: Journal of manipulative and physiological therapeutics (J Manipulative Physiol Ther) Vol. 29 Issue 7 Pg. 582-5 (Sep 2006) ISSN: 1532-6586 [Electronic] United States
• PMID: 16949949 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Anticoagulants

Topics

• Aged
• Anticoagulants (adverse effects)
• Atrial Fibrillation (drug therapy)
• Heart Failure (drug therapy)
• Hematoma, Epidural, Spinal (diagnosis, etiology, surgery)
• Humans
• Male
• Manipulation, Chiropractic (adverse effects)