1133 - Cervical Epidural Hematoma with Spinal Cord Injury Following Chiropractic Manipulation: A Case Report

Case Diagnosis: C4 AIS D spinal cord injury due to cervical epidural hematoma

Case Description: This patient is a 62-year-old male with no prior cervical history or vascular abnormalities who presented with a 2-day worsening history of severe neck pain and rapidly progressive neurological deficits after cervical manipulation by a chiropractor. Upon presentation through the hospital, he had severe left-sided hemiparesis and neurogenic bowel and bladder. Imaging revealed a large cervical epidural hematoma extending from C3-C6 with significant chord compression. He underwent a C3-C6 posterior laminectomy in fusion, along with evacuation of the hematoma. He had an uncomplicated postoperative course and was discharged to inpatient rehabilitation. Upon admission to inpatient rehab, he had already shown improved strength and was classified as having AC4 AISD spinal cord injury. By discharge, he was able to ambulate more than 100 50 feet with minimal assistance. His indwelling catheter was removed as his bladder function returned, and he no longer required a bowel program at the time of discharge.

Discussions: Cervical epidural hematoma is an exceedingly rare complication following chiropractic manipulation. There are few cases reported worldwide. A large retrospective analysis of patients receiving chiropractic manipulation from 2023 found no incidents of cervical epidural hematoma across 960,140 patients, further showing the rarity of this case. This patient had no known risk factors or contraindications to cervical manipulation before the incident.

Conclusions: This case illustrates that even healthy individuals can be vulnerable to vascular injury following manipulation. More data is needed to stratify risks for the general population.  Furthermore, current literature suggests that surgical decompression within the first 12 hours of symptom onset offers the best chance of neurological recovery. This patient waited over 48 hours to seek care, yet experienced a good recovery. Early recognition and intervention from providers are imperative for optimal outcomes.