Cervicothoracic epidural hematoma after chiropractic spinal manipulation therapy

Case report and review of the literature

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✓A spinal epidural hematoma is an extremely rare complication of cervical spine manipulation therapy (CSMT). The authors present the case of an adult woman, otherwise in good health, who developed Brown–Séquard syndrome after CSMT. Decompressive surgery performed within 8 hours after the onset of symptoms allowed for complete recovery of the patient's preoperative neurological deficit. The unique feature of this case was the magnetic resonance image showing increased signal intensity in the paraspinal musculature consistent with a contusion, which probably formed after SMT. The pertinent literature is also reviewed.

Abbreviations used in this paper:CSMT = cervical spine manipulation therapy; MR = magnetic resonance; SEH = spinal epidural hematoma.

Article Information

Address correspondence to: Maurizio Domenicucci, M.D., Via A. Graf, 42, 00137 Rome, Italy. email: smcapone@libero.it.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal (left) and axial (right) T2-weighted MR images showing an epidural blood mass extending from C-3 to T-1 and compressing the right posterolateral spinal cord.

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    This T1-weighted MR image from an MR imaging sequence shows marked gadolinium enhancement involving the posterior muscle mass, consistent with a paravertebral contusion.

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    Axial (upper) and sagittal (lower) T2-weighted follow-up MR images show a normal appearance of the spinal cord after the posterior surgical procedure.

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