Lumbar spinal epidural hematoma after chiropractic manipulation: A case report

Lumbar epidural hematoma is a very rare condition and can cause permanent neurological deficit needing urgent investigation and prompt intervention. We present here a case of lumbar epidural hematoma after chiropractic manipulation therapy for low back pain without any obvious predisposing factor. A fairly healthy and lively 72-year-old woman was admitted to our hospital because of grade 4 paresis after chiropractic manipulation therapy. She had no history of anticoagulation therapy. Magnetic resonance imaging (MRI) showed a spinal epidural hematoma with dural sac compression at the level of L3–L4. Rapid decompression of the spinal channel was performed. On follow-up 4 weeks after surgery, the patient was fully ambulatory and complained only of slight pain at the surgical site. MRI is the most useful method for diagnosing spinal epidural hematoma, the appropriate treatment for patients with neurological deficits being surgical decompression. Practitioners of chiropractic manipulation therapy should be aware of spinal epidural hematoma as a possible complication and should exercise caution in subgroups of patients on antithrombotic medication. Spinal epidural hematoma is a potentially reversible cause of neurological deterioration if diagnosed early and treated promptly.