McGilvery Wyatt, Eastin Marc, Sen Anish, Witkos Maciej
Department of Emergency Medicine, Loma Linda University Medical Center, Loma Lind 92354, CA, USA.
Department of Neurosurgery, Loma Linda University Medical Center, Loma Lind 92354, CA, USA.
Brain Sci. 2019 May 29;9(6):125. doi: 10.3390/brainsci9060125.
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. , , 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.
作者报告了一例病例，一名38岁男性因自行推拿颈椎后出现颈部疼痛和从右胸区域向下放射至右上肢远端的感觉异常为主诉前来急诊科就诊。急诊科最初通过颈椎X线和无造影剂的磁共振成像（MRI）检查未发现颈椎骨折；然而，有证据显示存在急性颈椎间盘突出（C3 - C7），其中C5 - C6处有严重突出及椎管狭窄。随即对C5 - C6进行了椎间盘切除术及前路椎间融合术，以减压颈脊髓。与因纤维环后部和髓核慢性退变导致的椎间盘突出相比，急性创伤性颈椎间盘突出较为罕见。创伤性颈椎间盘突出通常是由于非常大的外力导致颈椎过度前屈或后伸引起的。然而，有报告称颈椎脊柱推拿疗法（SMT）（有执照的专业人员施加旋转力成分）可导致颈部损伤。鉴于每年有1200万美国人接受SMT（鲍威尔，F.C.；哈尼根，W.C.；奥利韦罗，W.C. 脊柱推拿疗法缓解腰或颈疼痛的风险/效益分析。 ， ，73 - 79.），这可能令人担忧。本病例研究涉及一名能够对自己的颈椎施加足够旋转力，导致严重神经损伤并需要手术干预的个体。对于颈部疼痛的个体，应告知其SMT的并发症，并提供替代治疗方法，尤其是对于那些愿意自行推拿的人。
