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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

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

Abstract

Background:

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.

Conclusions:

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.

KEYWORDS:

Anticoagulants; Spinal epidural hematoma; Spinal manipulation

PMID:
31548880
PMCID:
PMC6751849
DOI:
10.1186/s12998-019-0264-9
[Indexed for MEDLINE]
Free PMC Article

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