Solheim Ole, Jorgensen Jan V, Nygaard Oystein P
Department of Neurosurgery, St.Olavs University Hospital, Trondheim, Norway.
Neurosurgery. 2007 Jul;61(1):E170-1; discussion E171. doi: 10.1227/01.neu.0000279740.61048.e2.
Spinal manipulation therapy is widely used for the treatment of lower-back pain. Serious complications to spinal manipulation are most often seen in the cervical region. We report the first case of a lumbar epidural hematoma after chiropractic manipulation.
A 77-year-old man with a long history of lower-back pain underwent chiropractic manipulation of the lower spine. He was receiving anticoagulation therapy as a result of chronic atrial fibrillation. After a manipulation session, he developed partial cauda equina syndrome with lower extremity paresis and urinary retention. Computed tomographic and magnetic resonance imaging scans showed an epidural hematoma at the L3 level.
We performed surgical evacuation of the hematoma through laminectomy of L3 and L4. During the follow-up period, his motor deficits improved, but the bladder dysfunction remained.
This is the first case report of a lumbar epidural hematoma after chiropractic manipulation. Even rare complications after chiropractic manipulation of the spine should be weighed against potential benefits of such treatment. Caution should be shown in patients receiving antithrombotic therapy.
脊柱推拿疗法广泛用于治疗下背痛。脊柱推拿的严重并发症最常出现在颈椎区域。我们报告了首例整脊推拿后发生腰椎硬膜外血肿的病例。
一名有长期下背痛病史的77岁男性接受了下脊柱的整脊推拿。由于慢性心房颤动，他正在接受抗凝治疗。一次推拿治疗后，他出现了部分马尾神经综合征，伴有下肢轻瘫和尿潴留。计算机断层扫描和磁共振成像扫描显示L3水平有硬膜外血肿。
我们通过L3和L4椎板切除术对血肿进行了手术清除。在随访期间，他的运动功能缺损有所改善，但膀胱功能障碍仍然存在。
这是首例整脊推拿后发生腰椎硬膜外血肿的病例报告。即使脊柱整脊推拿后出现罕见并发症，也应与这种治疗的潜在益处相权衡。接受抗血栓治疗的患者应谨慎对待。
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