1437 - Case of Acute Myelopathy After Cervical Spinal Traction in Patient with Undiagnosed Cervical Stenosis

Cervical stenosis with radiculopathy and myelopathy after spinal traction

Case Description: Case of a 55-year-old female evaluated at an Inpatient Rehabilitation Unit after cervical discectomy and fusion. Patient initially reported 2 weeks of cervicalgia partially relieved with lidocaine and ibuprofen. At a health fair, patient underwent spinal evaluation and referral to a Chiropractic clinic, where she received daily spinal adjustments for one week. During week two, cervical spinal traction was performed. Immediately afterward, patient developed severe cervical pain, weakness, and numbness radiating to her right arm and digits 1–3. Radiographs showed mild C5–C6 discogenic disease, inconsistent with symptom severity. Subsequent MRI demonstrated moderate-to-severe cervical stenosis with C5–C6 and C6–C7 bulging annulus, postcentral disc protrusion and spinal cord compression, concerning for radiculopathy and myelopathy. She was treated with high-dose corticosteroids, gabapentin, and tizanidine, with partial improvement. Due to ongoing deficits, she underwent anterior C5–C7 discectomy, arthrodesis, and fusion by Neurosurgery without complications. Patient completed inpatient rehabilitation successfully; symptoms progressively improved. 

Discussions: This case highlights a rare but serious complication following chiropractic cervical manipulation and traction in a patient with undiagnosed cervical stenosis. Although spinal manipulation is considered safe for subacute and chronic neck pain, it is not recommended as first-line monotherapy for acute neck pain. In patients with structural stenosis, manipulation may precipitate neurological deterioration. Clinicians should maintain a high index of suspicion for underlying pathology in patients with progressive symptoms and carefully consider the risks of high-velocity or traction-based interventions.

Conclusions:

Apart from vertebral artery dissection, side effects of spinal manipulation are not widely discussed. In patients with unrecognized spinal stenosis, cervical manipulation and traction can lead to serious complications that may need surgical intervention. Early recognition and timely referral are vital to reduce long-term morbidity. This case demonstrates the importance of cautious patient selection, guideline-based management and appropriate referral for cervical spine disorders.