Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2021; 9(22): 6501-6509
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6501
Spinal epidural hematoma after spinal manipulation therapy: Report of three cases and a literature review
Hua Liu, Tao Zhang, Tao Qu, Cheng-Wei Yang, Song-Kai Li
Hua Liu, Tao Zhang, Tao Qu, Cheng-Wei Yang, Song-Kai Li, Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
Author contributions: Liu H and Li SK provided the concept for the study and drafted the manuscript; Zhang T provided the images; Qu T and Yang CW performed the operations; all authors have read and approved the content of the manuscript.
Supported by Chinese People’s Liberation Army Medical Technology Youth Training Program, No. 20QNPY071.
Informed consent statement: Informed consent was obtained from the patients for the publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Song-Kai Li, MD, Associate Professor, Department of Spine Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, No. 333 Nanbinhe Road, Lanzhou 730050, Gansu Province, China. lisongkai@gmail.com
Received: April 5, 2021
Peer-review started: April 5, 2021
First decision: April 23, 2021
Revised: May 4, 2021
Accepted: May 17, 2021
Article in press: May 17, 2021
Published online: August 6, 2021
Abstract
BACKGROUND

Spinal manipulation therapy (SMT) has been widely used worldwide to treat musculoskeletal diseases, but it can cause serious adverse events. Spinal epidural hematoma (SEH) caused by SMT is a rare emergency that can cause neurological dysfunction. We herein report three cases of SEH after SMT.

CASE SUMMARY

The first case was a 30-year-old woman who experienced neck pain and numbness in both upper limbs immediately after SMT. Her symptoms persisted after 3 d of conservative treatment, and she was admitted to our hospital. Magnetic resonance imaging (MRI) demonstrated an SEH, extending from C6 to C7. The second case was a 55-year-old man with sudden back pain 1 d after SMT, numbness in both lower limbs, an inability to stand or walk, and difficulty urinating. MRI revealed an SEH, extending from T1 to T3. The third case was a 28-year-old man who suddenly developed symptoms of numbness in both lower limbs 4 h after SMT. He was unable to stand or walk and experienced mild back pain. MRI revealed an SEH, extending from T1 to T2. All three patients underwent surgery after failed conservative treatment. The three cases recovered to ASIA grade E on day 5, 1 wk, and day 10 after surgery, respectively. All patients returned to normal after 3 mo of follow-up.

CONCLUSION

SEH caused by SMT is very rare, and the condition of each patient should be evaluated in full detail before operation. SEH should be diagnosed immediately and actively treated by surgery.

Keywords: Spinal epidural hematoma, Spinal manipulation therapy, Spinal cord injury, Magnetic resonance imaging, Surgery, Case report

Core Tip: Spinal manipulation therapy (SMT) has been widely used worldwide to treat musculoskeletal diseases, but it can cause serious adverse events. Spinal epidural hematoma (SEH) caused by SMT is a rare emergency that can cause neurological dysfunction. We herein report three cases of SEH after SMT, and review a series of literature. All three patients underwent surgery after failed conservative treatment and returned to normal after 3 mo of follow-up. We focused on early recognition and surgical treatment.