Nonvascular complications following spinal manipulation.

BACKGROUND CONTEXT: Spinal manipulation is associated with various vascular and nonvascular complications. Most prior studies have focused on the vascular complications. PURPOSE: The purpose of this study is to better clarify the spectrum of nonvascular complications following spinal manipulation, and to help define the risks of manipulative treatment. STUDY DESIGN: Review of medical records and radiographic studies of appropriate subjects. PATIENT SAMPLE: Patients presenting to a neurosurgical practice over a 6-year period who suffered a qualitative worsening of symptoms immediately after spinal manipulative treatment. OUTCOME MEASURES: Neurological conditions were compared pre-manipulation, post-manipulation, and post-surgery. METHODS: Record review of 18 patients. RESULTS: Eighteen patients were identified who had received spinal manipulation and whose neurological condition immediately worsened. Injuries were sustained to the cervical, thoracic, and lumbar spine and resulted, variously, in myelopathy, paraparesis, cauda equina syndrome, and radiculopathy. Eighty-nine percent required surgery. Outcome was excellent in 50% and good in 37.5%. Three patients died from unrecognized malignancies. CONCLUSION: Spinal manipulation can be associated with significant complications, often requiring surgical intervention. Pretreatment scanning may help identify patients with significant risk factors, such as substantial disc herniations or occult malignancies. Prompt evaluation and intervention is necessary when symptoms worsen or neurological deficits develop.     

RE: Response to the editor regarding worsening disability status in multiple sclerosis predicts urologic complications

International Urology and Nephrology -     

Trauma-induced pneumothorax after "bear-hug back crack" home remedy: attempted spinal manipulation by a layperson

Spinal manipulation, as practiced by US-trained osteopathic physicians, is a safe and effective method of resolving patient pain and encouraging desirable physiologic improvement--often without pharmacologic intervention. Though novices, laypeople, and other clinicians also use manual techniques with similar goals in mind, their results are varied and sometimes dangerous to those they would help. The authors describe a case in which a layperson attempted spinal manipulation on a 20-year-old woman who later required a chest tube thoracostomy and hospitalization as a result of a pneumothorax. Osteopathic physicians are encouraged to consider patient risk factors for pneumothorax as a contraindication for the use of thoracic thrust techniques.     

高海拔地区脊椎小关节紊乱的手法康复治疗

高原是指海拔3000米以上的地区,由于特殊的气候环境对人体的不良影响,脊椎小关节紊乱(以下简称小关节紊乱)发病率相当高.本病表现复杂、多样化,并缺乏特异性,再加上临床医生对本病的认识不足或警惕性不高,使相当一部分患者较长时间不能得到正确的诊治或被误诊误治,严重影响到患者的正常生活、工作质量.     

Arthroscopy--"no-problem surgery". An analysis of complications in two thousand six hundred and forty cases

In a retrospective review of 3,261 arthroscopic procedures on the knee, 2,640 met the criteria for inclusion in this analysis. The patients' ages ranged from eight to eighty-three years. There were 1,541 male and 1,099 female patients. Eight hundred and ninety-five of the injuries were work-related. A tourniquet was used in 1,175 procedures and the average tourniquet time was thirty minutes. There were 216 complications over-all (8.2 per cent), 126 being designated as major and ninety-seven, as minor. The major complications that were evaluated were infections, hemarthrosis, adhesions, effusions, cardiovascular, neurological, reflex sympathetic dystrophy, and instrument breakage, and the minor complications were difficulties with wound-healing and ecchymosis. Chi-square analysis showed the following factors to be significant (p less than 0.05). Patients with an industrial injury had a higher rate of neurological complications and reflex sympathetic dystrophy. Diagnostic arthroscopy had the lowest over-all complication rate. Partial medical meniscectomy was associated with a higher over-all complication rate and the highest hemarthrosis rate, and partial lateral meniscectomy was associated with the highest rate of instrument breakage. Abrasion arthroplasty had the highest rate of complications of wound-healing, and subcutaneous lateral release was associated with the most adhesions. The sex of the patient and whether or not a tourniquet had been used had no effect on complications. The experience of the surgeon with arthroscopic procedures also had no correlation with the complication rate. Multiple regression analysis showed that two factors (age and, if a tourniquet was used, the tourniquet time) were dominant predictors of complications. From these data, a model was devised for predicting which patients were at risk for complications and their relative levels of risk. Certain complications may be preventable, and for others the risk factors can be reduced. The high-risk patients in our series were fifty years old or older and had a tourniquet time of sixty minutes or longer.