Cooper Jesse, Battaglia Patrick, Reiter Todd
1Department of Chiropractic Medicine, Baylor Scott and White Health, 300 University Blvd., Building A, Round Rock, TX 78665 USA.
2Department of Chiropractic, Logan University, 1851 Schoettler Road, Chesterfield, MO 63017 USA.
Chiropr Man Therap. 2019 Sep 19;27:41. doi: 10.1186/s12998-019-0264-9. eCollection 2019.
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.
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.
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.
脊柱硬膜外血肿是一种罕见病症，通常继发于创伤和凝血病。据我们所知，我们报告了首例因医源性高凝状态而进行自我颈部推拿，进而导致脊柱硬膜外血肿及随后四肢瘫痪的患者。
一名63岁男性在对颈椎进行自我推拿1天后，因肩胛间疼痛加重并放射至颈部而就诊于急诊科。入院时发现他患有凝血病，继发于用于治疗心房颤动的慢性华法林治疗。推拿后约48小时，患者突然出现四肢瘫痪和低血压。紧急磁共振成像显示从下颈椎到胸椎有多节段脊柱硬膜外血肿。
为清除脊柱硬膜外血肿，实施了C7部分、T1和T2完全以及T3双侧部分椎板切除术。经过为期2周的急性住院康复治疗，患者恢复到了基线功能状态。该病例突出了颈部自我推拿以及可能对颈椎施加显著拉伸或扭矩的其他活动的风险。它还呈现了一种临床情况，即脊柱推拿治疗从业者应意识到正在接受抗凝治疗的患者。
