A Case Report: Adverse Outcomes Following Cervical Spine Manipulation – A New Chronic Neck Patient?
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Abstract
Introduction: Cervical cord injury from spinal manipulation is not rare. Safety protocols and predictors have been emphasized to prevent adverse events. In October 2012, the International Federation of Orthopaedic Manipulative Physical Therapists approved a framework for safer cervical spine assessment, focusing on the risk of Cervical Arterial and Neurological Dysfunction. This case study investigated whether cervical spine manipulation in an asymptomatic neck could cause soft tissue lesions.
Clinical and radiological follow up: To explore this potential cause of the patient’s neurological symptoms in this single case, a Computer Tomography and Magnetic Resonance Imaging scan were requested. The supervising clinician emphasized the importance of positioning the patient’s head and neck according to her specific clinical findings before performing the radiological scans of the cervical spine.
Case Report Findings: Significant radiological findings, including C1 anomalies and soft tissue lesions were revealed. Imaging identified C1 Spina Bifida, absence of the Rectus Capitus Minor muscle, C1-2 hyper-rotation with borderline Atlas-axis facet subluxation, lesions to the Anterior Longitudinal Ligament and central Alar/Cruciate ligament complex, as well as unphysiological contact between the spinal cord and ligament structures at the C0-1-2 level.
Discussion: This Case Report highlights the importance of thorough clinical assessment and individualized imaging before cervical spine manipulation. Undetected structural anomalies and soft tissue vulnerabilities can increase the risk of adverse effects. Standard radiological protocols may lack sensitivity to functional biomechanics, highlighting the need for a more precise diagnostic approach. Adhering to established clinical guidelines can enhance patient safety and treatment outcomes
Conclusion: These Clinical and Radiological findings underscore the importance of integrating comprehensive clinical assessment with individualized pre-manipulative imaging to enhance patient safety in cervical spine manipulation. Identifying pre-existing structural vulnerabilities through advanced imaging can help reduce risks associated with manipulative techniques. Furthermore, aligning radiological findings with clinical evaluation ensures a more precise diagnosis, reducing the likelihood of overlooked lesions and subsequent complications.
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