| Abstract/Notes |
Background: Multimodal chiropractic therapies are well known to reduce pain, improve range of motion and assist with functional rehabilitation of cervical spine dysfunction syndromes. Amongst the critical known contributing risks associated with cervical spinal manipulation are injuries to the vertebral and carotid arteries. Osteoarthritis or rheumatologic arthritides with associated osteophytosis or syndesmophytosis are not considered major risk factors for adverse events such as neuropraxia or vascular dissection.
Case Presentation: A 59-year-old male presented to an outpatient chiropractic clinic with a chief complaint of daily headaches and numbness of the right hand at night. History and review of symptoms obtained by the chiropractor at the initial appointment were devoid of any pertinent red flags or relevant medical history. Physical examination indicated appropriateness of spinal manipulative therapy as management of neck pain and headaches. 10 minutes following treatment, the patient developed dysphasia and dysarthria and was evaluated in the emergency department. He underwent extensive CT, MRI, and laryngoscopy diagnostic procedures to rule out the possibility of a stroke, vertebra-basilar-insufficiency (VBI), or space occupying lesion. The imaging revealed a right sided vocal cord palsy, severe anterior vertebral osteophytosis, multiple levels of canal stenosis, disc disease, and post-traumatic vertebral end-plate degeneration likely caused by multiple neck injuries earlier in life. He was treated with IV corticosteroids as well as occupational and speech therapies, which improved his swallowing and speech except for mild hoarseness.
Conclusion: The risks for spinal manipulation especially in the cervical region should include osteophytosis and degenerative processes that may affect the surrounding neural and vascular soft tissues. Given the rarity and extremely low incidence of adverse effects related to cervical spine manipulation, it would be reasonable to assume that this type of adverse effect could have happened in association with any activity of daily living demanding a fast head or neck rotation. More research is needed on post-traumatic spinal and juxta-spinal degeneration and their effects on different soft tissues and function with the goal of improving clinical safety and practical procedures within chiropractic clinics.
Author keywords: chiropractic, manipulation, vocal cord palsy, recurrent laryngeal nerve, glosso- pharyngeal, vagus, hypoglossal, Tapia syndrome
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