Poster 519 Acute Cervical Myelopathy Caused By Chiropractic Manipulation in a Young Person With a Cervical Osteochondroma: A Case Report

Abstract

Case Description: The patient had a 2-year history of left-arm paresthesias, but no other disability, and went to a chiropractor for neck pain. Promptly following cervical manipulation he developed quadriparesis. Computed tomography revealed a bony outgrowth arising from the left lamina of cervical vertebrae two (C2) extending into the spinal canal. The mass, radiographically consistent with an osteochondroma, caused severe cord compression. The T2-signal was increased from the foramen magnum to level C3 suggestive of a coinciding cord contusion. An emergent C2 laminectomy and extradural mass resection was performed. On admission to rehabilitation, the patient had clinical findings of an incomplete cervical myelopathy. Physical examination revealed right-sided weakness, 3/5 and 4/5 in the arm and leg muscles, respectively. Tone was increased in the right leg with clonus at the ankle. He had sensory disassociation with crossed impairment of light-touch, pain and temperature sensation from C2 caudally and uncrossed diminished vibration and proprioception. These features indicated a lesion mainly involving the right hemi-cord, or Brown-Séquard Syndrome. Setting: Acute inpatient rehabilitation unit. Results or Clinical Course: At 6-month follow-up he continues to have residual sensorimotor deficits. Discussion: Spinal osteochondromas are rare with an incidence of <4% and can cause myelopathy due to mass-effect. Over time subtle myelopathic symptoms may occur as the spinal cord becomes tethered by the enlarging mass but go relatively unnoticed. This predisposed the patient to a higher risk of injury associated with chiropractic manipulation that ultimately resulted in cord contusion and acute neurological deterioration. Conclusions: Despite having antecedent paresthesias this patient underwent chiropractic manipulation causing an acute cervical myelopathy because of an unrecognized osteochondroma at C2. Individuals contemplating chiropractic manipulation of the spine should first be cleared of any underlying orthopedic or neurologic disorder, and vigorous manipulation should always be avoided.