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Chiropr Man Therap. 2019 Sep 19;27:41. doi: 10.1186/s12998-019-0264-9. eCollection 2019.

Spinal epidural hematoma in a patient on chronic anticoagulation therapy performing self-neck manipulation: a case report.

Author information

1Department of Chiropractic Medicine, Baylor Scott and White Health, 300 University Blvd., Building A, Round Rock, TX 78665 USA.
2Department of Chiropractic, Logan University, 1851 Schoettler Road, Chesterfield, MO 63017 USA.
3Department of Physical Medicine and Rehabilitation, Novant Health Forsyth Medical Center, 3333 Silas Creek Parkway, Winston-Salem, NC 27103 USA.



Spinal epidural hematoma is a rare condition usually secondary to trauma and coagulopathy. To the best of our knowledge, we present the first case of a patient with an iatrogenic hypercoaguable state performing self-neck manipulation, which resulted in a spinal epidural hematoma and subsequent quadriparesis.

Case presentation:

A 63-year-old man presented to the emergency department with worsening interscapular pain radiating to his neck 1 day after performing self-manipulation of his cervical spine. He was found to be coagulopathic upon admission, secondary to chronic warfarin therapy for the management of atrial fibrillation. Approximately 48 h after the manipulation, the patient became acutely quadriparetic and hypotensive. Urgent magnetic resonance imaging revealed a multilevel spinal epidural hematoma from the lower cervical to thoracic spine.


Partial C7, complete T1 and T2, and partial T3 bilateral laminectomy was performed for evacuation of the spinal epidural hematoma. Following a 2-week course of acute inpatient rehabilitation, the patient returned to his baseline functional status. This case highlights the risks of self-manipulation of the neck and potentially other activities that significantly stretch or apply torque to the cervical spine. It also presents a clinical scenario in which practitioners of spinal manipulation therapy should be aware of patients undergoing anticoagulation therapy.


Anticoagulants; Spinal epidural hematoma; Spinal manipulation

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