Nonvascular complications following spinal manipulation.

Background Context: Spinal manipulation is associated with various vascular and nonvascular complications. Most prior studies have focused on the vascular complications.

Purpose: The purpose of this study is to better clarify the spectrum of nonvascular complications following spinal manipulation, and to help define the risks of manipulative treatment.

Study Design: Review of medical records and radiographic studies of appropriate subjects.

Patient Sample: Patients presenting to a neurosurgical practice over a 6-year period who suffered a qualitative worsening of symptoms immediately after spinal manipulative treatment.

Outcome Measures: Neurological conditions were compared pre-manipulation, post-manipulation, and post-surgery.

Methods: Record review of 18 patients.

Results: Eighteen patients were identified who had received spinal manipulation and whose neurological condition immediately worsened. Injuries were sustained to the cervical, thoracic, and lumbar spine and resulted, variously, in myelopathy, paraparesis, cauda equina syndrome, and radiculopathy. Eighty-nine percent required surgery. Outcome was excellent in 50% and good in 37.5%. Three patients died from unrecognized malignancies.

Conclusion: Spinal manipulation can be associated with significant complications, often requiring surgical intervention. Pretreatment scanning may help identify patients with significant risk factors, such as substantial disc herniations or occult malignancies. Prompt evaluation and intervention is necessary when symptoms worsen or neurological deficits develop.