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David G. Malone, Nevan G. Baldwin, Frank J. Tomecek, Christopher M. Boxell, Steven E. Gaede, Christopher G. Covington and Kenyon K. Kugler


The authors report a series of 22 patients in whom major complications developed after cervical spinal manipulation therapy (CSMT). A second objective was to estimate the regional incidence of these complications and to compare it with the very low incidences reported in the literature.


During a 5-year period, practioners at a single group neurosurgical practice in Tulsa, Oklahoma, treated 22 patients, who were markedly worse during, or immediately after, CSMT. The details of these cases are reported. The 1995 US Government National Census was used to define the regional referral population for Tulsa. The published data regarding the incidence of serious CSMT-related complications and the rate of CSMTs undertaken nationally were used to estimate the expected number of CSMT-related complications in the authors' region. The number (22 cases) reported in this series was used to estimate the actual regional incidence.

Complications in the series included radiculopathy (21 cases), myelopathy (11 cases), Brown–Séquard syndrome (two cases), and vertebral artery (VA) occlusion (one case). Twenty-one patients underwent surgery. Poor outcomes were observed in three, outcome was unchanged in one, and 17 improved. The number of patients in this series exceeded the expected number for the region.


Cervical spinal manipulation therapy may worsen preexisting cervical disc herniation or cause disc herniation resulting in radiculopathy, myelopathy, or VA compression. In cases of cervical spondylosis, CSMT may also worsen preexisting myelopathy or radiculopathy. Manipulation of the cervical spine may also be associated with higher complication rates than previously reported.

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Maurizio Domenicucci, Alessandro Ramieri, Maurizio Salvati, Christian Brogna and Antonino Raco

. A rapid radiological diagnosis using MR imaging and surgical evacuation of the SEH appears to be the safest approach for ensuring a good neurological recovery. References 1 Cox DM : Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice . Neurosurg Focus 13 : 6 E1 , 2002 . (Letter) 2 Dabbert O , Freeman DG , Weis AJ : Spinal meningeal hematoma, warfarin therapy and chiropractic adjustment . JAMA 214 : 2058 , 1970 3 DeFranca GG , Manipulative techniques for the cervical spine

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Timothy C. Chin-See-Chong, Pravesh S. Gadjradj, Robert J. Boelen and Biswadjiet S. Harhangi

, 2015 16 Malone DG , Baldwin NG , Tomecek FJ , Boxell CM , Gaede SE , Covington CG , : Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice . Neurosurg Focus 13 : 6 ecp1 , 2002 17 Muheremu A , Niu X , Wu Z , Muhanmode Y , Tian W : Comparison of the short- and long-term treatment effect of cervical disk replacement and anterior cervical disk fusion: a meta-analysis . Eur J Orthop Surg Traumatol 25 : Suppl 1 S87 – S100 , 2015 18 Mummaneni PV , Haid RW : The