Spinal cord lesion and ischemic stroke after chiropractic: a case report

Abstract

Context: Chiropractic is a form of spinal manipulation used to treat cervical pain. This therapy is considered safer than chronic use of anti-inflammatory drugs, opioids or spine surgery. However, chiropractic may cause severe complications such as myelopathy and ischemic stroke. Case report: A 48-year-old woman was admitted to our hospital due to acute tetraparesis. During a chiropractic session for chronic neck pain, patient referred lancinating cervical pain, weakness in the upper and lower limbs, and numbness below the level of the neck. Neurologic examination showed grade two tetraparesis with preserved arm abduction. Pain and vibratory sensation were reduced in trunk, upper and lower limbs. We considered a C5 level spinal cord injury. Cervical spine magnetic resonance imaging revealed a transdiscal fracture of C5-C6 vertebrae. The fracture led to an epidural hematoma and spinal cord compression. Cervical spine displayed ligamenta flava thickening, which may be associated with an undiagnosed ankylosing spondylitis. We also found bilateral vertebral occlusion of V1 and V2 segments. Cerebellar restricted diffusion suggested posterior circulation stroke. We believe that rigidity associated with ankylosing spondylitis favored spinal fracture during chiropractic. Patient was treated with 24mg/day of dexamethasone and 100mg/day of aspirin. Spinal cord decompression surgery was indicated. Unfortunately, in the last followup there was no improvement in patient motor status. Conclusions: Transdiscal C5-C6 fracture led to compressive myelopathy and cerebellar stroke. Safety of chiropractic should be better investigated in specific populations such as ankylosing spondylitis patients.