scholarly journals Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice

2002 ◽  
Vol 13 (6) ◽  
pp. 1-8 ◽  
Author(s):  
David G. Malone ◽  
Nevan G. Baldwin ◽  
Frank J. Tomecek ◽  
Christopher M. Boxell ◽  
Steven E. Gaede ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Disc Herniation ◽  
Spinal Manipulation ◽  
Cervical Disc ◽  
Published Data ◽  
Complication Rates ◽  
Single Group ◽  
Expected Number ◽  
Manipulation Therapy ◽  
Number Of Patients

Object 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. Methods 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. Conclusions 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.

scholarly journals Self Manipulated Cervical Spine Leads to Posterior Disc Herniation and Spinal Stenosis

2019 ◽  
Vol 9 (6) ◽  
pp. 125 ◽  
Author(s):  
Wyatt McGilvery ◽  
Marc Eastin ◽  
Anish Sen ◽  
Maciej Witkos
Keyword(s):  
Emergency Department ◽  
Neck Pain ◽  
Spinal Stenosis ◽  
Disc Herniation ◽  
Spinal Manipulation ◽  
Cervical Spinal Cord ◽  
Cervical Vertebrae ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Manipulation Therapy

The authors report a case in which a 38-year-old male who presented himself to the emergency department with a chief complaint of cervical neck pain and paresthesia radiating from the right pectoral region down his distal right arm following self-manipulation of the patient’s own cervical vertebrae. Initial emergency department imaging via cervical x-ray and magnetic resonance imaging (MRI) without contrast revealed no cervical fractures; however, there was evidence of an acute cervical disc herniation (C3–C7) with severe herniation and spinal stenosis located at C5–C6. Immediate discectomy at C5–C6 and anterior arthrodesis was conducted in order to decompress the cervical spinal cord. Acute traumatic cervical disc herniation is rare in comparison to disc herniation due to the chronic degradation of the posterior annulus fibrosus and nucleus pulposus. Traumatic cervical hernias usually arise due to a very large external force causing hyperflexion or hyperextension of the cervical vertebrae. However, there have been reports of cervical injury arising from cervical spinal manipulation therapy (SMT) where a licensed professional applies a rotary force component. This can be concerning, considering that 12 million Americans receive SMT annually (Powell, F.C.; Hanigan, W.C.; Olivero, W.C. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery 1993, 33, 73–79.). This case study involved an individual who was able to apply enough rotary force to his own cervical vertebrae, causing severe neurological damage requiring surgical intervention. Individuals with neck pain should be advised of the complications of SMT, and provided with alternative treatment methods, especially if one is willing to self manipulate.

Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws

2013 ◽  
Vol 19 (5) ◽  
pp. 614-623 ◽  
Author(s):  
Hiroyuki Yoshihara ◽  
Peter G. Passias ◽  
Thomas J. Errico
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Preoperative Evaluation ◽  
Pedicle Screws ◽  
Complication Rates ◽  
Lateral Mass ◽  
Subaxial Cervical Spine ◽  
Number Of Patients ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws

Object Lateral mass screws (LMS) have been used extensively with a low complication rate in the subaxial spine. Recently, cervical pedicle screws (CPS) have been introduced, and are thought to provide more optimal stabilization of the subaxial spine in certain circumstances. However, because of the concern for neurovascular injury, the routine use of CPS in this location remains controversial. Despite this controversy, however, there are no articles directly comparing screw-related complications of each procedure in the subaxial cervical spine. The purpose of this study was to evaluate screw-related complications of LMS and CPS in the subaxial cervical spine. Methods A PubMed/MEDLINE and Cochrane Collaboration Library search was executed, using the key words “lateral mass screw” and “cervical pedicle screw.” Clinical studies evaluating surgical procedures of the subaxial cervical spine in which either LMS or CPS were used and complications were reported were included. Studies in which the number of patients who had subaxial cervical spine surgery and the number of screws placed from C-3 to C-7 could not be specified were excluded. Data on screw-related complications of each study were recorded and compared. Results Ten studies of LMS and 12 studies of CPS were included in the analysis. Vertebral artery injuries were slightly but statistically significantly higher with the use of CPS relative to LMS in the subaxial cervical spine. Although the use of LMS was associated with a higher rate of screw loosening, screw pullout, loss of reduction, pseudarthrosis, and revision surgery, this finding was not statistically significant. Conclusions Based on the available literature, it appears that perioperative neurological and late biomechanical complication rates, including pseudarthrosis, are similarly low for both LMS and CPS techniques. In contrast, vertebral artery injuries, although statistically significantly more common when using CPS, are extremely rare with both techniques, which may justify their nonroutine use in select cases. Given the paucity of well-designed studies available, this recommendation may be a reflection of deficiencies in the available studies. Surgeons using either technique should have intimate knowledge of cervical anatomy and an adequate preoperative evaluation for each patient, with the final selection based on individual case requirements and anatomical limitations.

Ruptured Cervical Disc After Spinal Manipulation Therapy

Spine ◽  
2002 ◽  
Vol 27 (3) ◽  
pp. E80-E82 ◽  
Author(s):  
Sheng-Hong Tseng ◽  
Swei-Ming Lin ◽  
Yun Chen ◽  
Chih-Hsien Wang
Keyword(s):  
Spinal Manipulation ◽  
Cervical Disc ◽  
Manipulation Therapy

scholarly journals Oblique Sagittal Images Prevent Underestimation of the Neuroforaminal Stenosis Grade Caused by Disc Herniation in Cervical Spine MRI

2018 ◽  
Vol 190 (10) ◽  
pp. 946-954 ◽  
Author(s):  
Laurent Kintzelé ◽  
Christoph Rehnitz ◽  
Hans-Ulrich Kauczor ◽  
Marc-André Weber
Keyword(s):  
Cervical Spine ◽  
Disc Herniation ◽  
Sagittal Plane ◽  
Cervical Disc ◽  
Cervical Spine Surgery ◽  
Valuable Adjunct ◽  
Significant Difference ◽  
Disc Herniations ◽  
Oblique Images ◽  
Spine Mri

Purpose To identify whether standard sagittal MRI images result in underestimation of the neuroforaminal stenosis grade compared to oblique sagittal MRI images in patients with cervical spine disc herniation. Materials and Methods 74 patients with a total of 104 cervical disc herniations compromising the corresponding nerve root were evaluated. Neuroforaminal stenosis grades were evaluated in standard and oblique sagittal images by one senior and one resident radiologist experienced in musculoskeletal imaging. Oblique images were angled 30° towards the standard sagittal plane. Neuroforaminal stenosis grades were classified from 0 (no stenosis) to 3 (high grade stenosis). Results Average neuroforaminal stenosis grades of both readers were significantly lower in standard compared to oblique sagittal images (p < 0.001). For 47.1 % of the cases, one or both readers reported a stenosis grade, which was at least 1 grade lower in standard compared to oblique sagittal images. There was also a significant difference when looking at patients who had neurological symptoms (p = 0.002) or underwent cervical spine surgery subsequently (p = 0.004). Interreader reliability, as measured by kappa value, and accordance rates were better for oblique sagittal images (0.94 vs. 0.88 and 99 % vs. 93 %). Conclusion Standard sagittal images tend to underestimate neuroforaminal stenosis grades compared to oblique sagittal images and are less reliable in the evaluation of disc herniations within the cervical spine MRI. In order to assess the potential therapeutic consequence, oblique images should therefore be considered as a valuable adjunct to the standard MRI protocol for patients with a radiculopathy. Key Points  Citation Format

Mild Cervical Spine Trauma Showing Symptomatic Calcified Cervical Disc Herniation in a Child

Spine ◽  
2003 ◽  
Vol 28 (5) ◽  
pp. E93-E94 ◽  
Author(s):  
Klaus-D. Schaser ◽  
John F. Stover ◽  
Max J. Kaeaeb ◽  
N. P. Haas ◽  
Thomas Mittlmeier
Keyword(s):  
Cervical Spine ◽  
Disc Herniation ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cervical Spine Trauma ◽  
Spine Trauma

scholarly journals Cervical spine surgery in professional athletes: a systematic review

2016 ◽  
Vol 40 (4) ◽  
pp. E10 ◽  
Author(s):  
Andrei F. Joaquim ◽  
Wellington K. Hsu ◽  
Alpesh A. Patel
Keyword(s):  
Systematic Review ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Disc Herniation ◽  
Cervical Disc Herniation ◽  
Return To Play ◽  
Cervical Disc ◽  
Cervical Spine Surgery ◽  
Spine Pathology ◽  
High Level

Cervical surgery is one of the most common surgical spinal procedures performed around the world. The authors performed a systematic review of the literature reporting the outcomes of cervical spine surgery in high-level athletes in order to better understand the nuances of cervical spine pathology in this population. A search of the MEDLINE database using the search terms “cervical spine” AND “surgery” AND “athletes” yielded 54 abstracts. After exclusion of publications that did not meet the criteria for inclusion, a total of 8 papers reporting the outcome of cervical spine surgery in professional or elite athletes treated for symptoms secondary to cervical spine pathology (focusing in degenerative conditions) remained for analysis. Five of these involved the management of cervical disc herniation, 3 were specifically about traumatic neurapraxia. The majority of the patients included in this review were American football players. Anterior cervical discectomy and fusion (ACDF) was commonly performed in high-level athletes for the treatment of cervical disc herniation. Most of the studies suggested that return to play is safe for athletes who are asymptomatic after ACDF for cervical radiculopathy due to disc herniation. Surgical treatment may provide a higher rate of return to play for these athletes than nonsurgical treatment. Return to play after cervical spinal cord contusion may be possible in asymptomatic patients. Cervical cord signal changes on MRI may not be an absolute contraindication for return to play in neurologically intact patients, according to some authors. Cervical contusions secondary to cervical stenosis may be associated with a worse outcome and a higher recurrence rate than those those secondary to disc herniation. The evidence is low (Level IV) and individualized treatment must be recommended.

scholarly journals Three-level cervical disc herniation

2015 ◽  
Vol 29 (3) ◽  
pp. 309-315
Author(s):  
Andrei St. Iencean ◽  
Ion Poeata
Keyword(s):  
Cervical Spine ◽  
Disc Herniation ◽  
The Elderly ◽  
Cervical Disc Herniation ◽  
Herniated Disc ◽  
Cervical Disc ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Spine Pathology ◽  
Rapid Relief

Abstract Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6) treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

scholarly journals Role of Magnetic Resonance Imaging in the Diagnosis of Cervical Disc Herniation: Comparison with Peroperative Findings

2014 ◽  
Vol 13 (2) ◽  
pp. 59-62
Author(s):  
Tarannum Morshed ◽  
Shahara Haque ◽  
Md Abdul Awwal ◽  
Naffisa Abedin ◽  
Sadia Sultana
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cervical Spine ◽  
Magnetic Resonance ◽  
Clinical Features ◽  
Disc Herniation ◽  
Predictive Value ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Resonance Imaging

The present method comparison study was carried out in the Radiology and Imaging Department of Dhaka Medical College & Hospital, Dhaka during the period of January 2012 to December 2013 to evaluate the role of Magnetic Resonance Imaging in the diagnosis of cervical disc herniation. A total of 40 patients having clinical features of cervical disc herniation with neck pain referred to the Department of Radiology & Imaging for MRI of their cervical spine were included in the study. At first all the patients were evaluated by detail history and clinical examination with special emphasis on clinical features. Then subsequently MRI of cervical spine was performed in all cases. The MRI report was checked by a competent radiologist of the department of Radiology and imaging DMCH. Among these 40 patients 11 were operated in department of neurosurgery, DMCH and 29 were operated in spine surgery unit, Department of Orthopaedic, BSMMU, Dhaka. The MRI and peroperative findings of these 40 patients were analyzed for the study. MRI findings correlated well in most of the cases with preoperative findings. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRI in the diagnosis of cervical disc herniation were 94.12%, 83.33%, 96.97%, 71.43% and 92.5% respectively. Therefore it can be concluded that MRI may be used as a reliable tool with which we can assess the level, type and position of cervical disc herniation and can plan the subsequent appropriate management in majority of cases.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21071

scholarly journals Evaluation of Concordance between Degenerative Changes on Neck X-Ray and Symptomatic Cervical Disc Herniation

2020 ◽  
Vol 8 (2) ◽  
pp. 22
Author(s):  
Amir Abbas Ghasemi ◽  
Saber Ramezanpour
Keyword(s):  
Cervical Spine ◽  
Disc Herniation ◽  
Demographic Data ◽  
Degenerative Changes ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
X Ray ◽  
Level Group

Objectives: Radiographic assessment of cervical spine can help find the etiology of neck symptoms, however association between these findings is debatable. The aim of this study was to investigate the association between degenerative changes of the cervical spine and symptomatic cervical disc herniation. Patients and Methods: This cross-sectional retrospective study included 160 patients who underwent anterior cervical discectomy and fusion between February 2012 and June 2017 for cervical disc herniation. Demographic data, patients’ symptoms and radiographic findings and indices were evaluated. The Chi-Square (X2) and one-way ANOVA were used to compare the observed data. Results: A total of 160 patients were studied. Among them, 83 (52%) were male and 77(48%) were female. The patients were classified into four groups on the basis of imaging findings: 89(55.6%) with degenerative changes and symptomatic disc herniation at the same level (group 1), 40(25%) with degenerative changes at a level adjacent to symptomatic level (group 2), 23(14.3%) with symptomatic herniation both at the degenerated level and at level immediately adjacent to it (group 3), and 8(5%) symptomatic herniation and degenerative changes at non-adjacent levels (group 4). There were no significant differences among the four groups from the viewpoint of gender, age, symptoms, smoking and sedentary life style. The study also showed no significant differences between groups with respect to Ishihara index, disc height and posterior osteophyte length. Conclusion: Degenerative changes visible on neck X-ray can be useful clues to the symptomatic disc herniation, but disc herniation may also develop at adjacent and non-adjacent levels.

Sign in / Sign up

Export Citation Format

Share Document