Massive hematothorax after thoracic spinal manipulation for acute thoracolumbar pain

Abstract

Spinal manipulation usually represents a widely used and effective method for physicians in order to relieve acute patient pain and muscular dysbalance. Although life-threatening complications (e.g. pneumothorax, vertebral artery dissection, stroke) after manual treatment are reported with regard to actual medical literature millions of patients undergo manual treatment to manage thoracolumbar pain each year. The authors present the case of a 17 year old male patient with a life-threatening hematothorax after thoracic high velocity spinal manipulation for acute thoracolumbar pain. The patient required emergency chest tube thoracostomy and afterwards thoracoscopic haemostasis for an intercostal venous lesion. A massive hematothorax after spinal manipulation represents an extremely rare but life-threatening complication. Physicians are encouraged to promote the benefits of manual/chiropratic therapy on the one hand but on the other hand are obliged to educate about potential serious dangers and adverse events.

Adverse Events Due to Chiropractic and Other Manual Therapies for Infants and Children: A Review of the Literature

“…Adverse events were defined as mild (transient effects lasting b 24 hours, eg, crying or discomfort), moderate (requiring medical/general practitioner treatment), or severe (requiring hospital treatment) 16 39 Wilson et al, 41 Zimmerman et al, 52 Humphreys, 21 Alcantara et al, 25,[35][36][37][38] Posadzki and Ernst, 24 Simonian and Staheli, 43 53 Ziv et al, 54 Jacobi et al, 46 L'Ecuyer, 55 Klougart et al, 51 Rageot, 47 40 Miller and Benfield, 26 Doyle, 44 Holla et al, 42 Hayes and Bezilla, 27 Hayden et al, 28 Dobson et al, 22 Pohlman and Holton-Brown, 23 Sawyer et al, 29 Koch et al, 30,31 Bronfort et al, 34 Philippi et al, 32 Rowe et al 33 Manual search of reference lists revealed additional 6 articles: Wiberg et al, 59 Straub et al, 60 Sandell et al, 61 Balon and Aker, 62 Khorshid et al, 63 …”

The Perils of Complementary Alternative Medicine

“…One must remember that acupuncture and chiropractice are the most studied CAM therapies with many control studies that have also reported side effects. Even so, when searching PubMed, one can find more than 1,800 articles about chiropractic manipulation, but only three discuss the dangers in these manipulations 20–22. Some leading Israeli hospitals include CAM in their services, mainly in pain clinics.…”

Safety of thrust joint manipulation in the thoracic spine: a systematic review

“…A total of 10 cases, reported in seven articles, were analysed for this systematic review [33][34][35][36][37][38][39] (Table 3).…”