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Open AccessCase Report

Self Manipulated Cervical Spine Leads to Posterior Disc Herniation and Spinal Stenosis

1
Department of Emergency Medicine, Loma Linda University Medical Center, Loma Lind, CA 92354, USA
2
Department of Neurosurgery, Loma Linda University Medical Center, Loma Lind, CA 92354, USA
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(6), 125; https://doi.org/10.3390/brainsci9060125
Received: 29 April 2019 / Revised: 24 May 2019 / Accepted: 27 May 2019 / Published: 29 May 2019
(This article belongs to the Special Issue Surgery for Spine Disease and Intractable Pain)
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Abstract

The authors report a case in which a 38-year-old male who presented himself to the emergency department with a chief complaint of cervical neck pain and paresthesia radiating from the right pectoral region down his distal right arm following self-manipulation of the patient’s own cervical vertebrae. Initial emergency department imaging via cervical x-ray and magnetic resonance imaging (MRI) without contrast revealed no cervical fractures; however, there was evidence of an acute cervical disc herniation (C3–C7) with severe herniation and spinal stenosis located at C5–C6. Immediate discectomy at C5–C6 and anterior arthrodesis was conducted in order to decompress the cervical spinal cord. Acute traumatic cervical disc herniation is rare in comparison to disc herniation due to the chronic degradation of the posterior annulus fibrosus and nucleus pulposus. Traumatic cervical hernias usually arise due to a very large external force causing hyperflexion or hyperextension of the cervical vertebrae. However, there have been reports of cervical injury arising from cervical spinal manipulation therapy (SMT) where a licensed professional applies a rotary force component. This can be concerning, considering that 12 million Americans receive SMT annually (Powell, F.C.; Hanigan, W.C.; Olivero, W.C. A risk/benefit analysis of spinal manipulation therapy for relief of lumbar or cervical pain. Neurosurgery 1993, 33, 73–79.). This case study involved an individual who was able to apply enough rotary force to his own cervical vertebrae, causing severe neurological damage requiring surgical intervention. Individuals with neck pain should be advised of the complications of SMT, and provided with alternative treatment methods, especially if one is willing to self manipulate. View Full-Text
Keywords: cervical disk herniation; spinal stenosis; neurosurgery; discectomy; arthrodesis; anterior approach; self manipulation; cervical spine; spinal manipulation therapy; acute trauma cervical disk herniation; spinal stenosis; neurosurgery; discectomy; arthrodesis; anterior approach; self manipulation; cervical spine; spinal manipulation therapy; acute trauma
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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McGilvery, W.; Eastin, M.; Sen, A.; Witkos, M. Self Manipulated Cervical Spine Leads to Posterior Disc Herniation and Spinal Stenosis. Brain Sci. 2019, 9, 125.

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