From the June issue of the Journal of Clinical Neuroscience:
Wang CC, Kuo JR, Chio CC, Tsai TC. Acute paraplegia following chiropractic therapy. J Clin Neurosci 2006;13:578-581. [full text by subscription]
Abstract: We report a 44-year-old man suffering complete paraplegia due to paraspinal and epidural abscess, following chiropractic therapy for severe back pain and whose diagnosis was delayed. He received an immediate laminectomy from T(3) through T(6) to decompress the full extent of the abscess and appropriate antibiotic therapy for 4 weeks postoperatively for the identified microorganism (Staphylococcus aureus). After 3 months of rehabilitation, he had recovered bladder function with moderate left lower extremity paresis. We emphasise the importance of urgent spinal gadolinium-enhanced MRI in those patients with localised back pain and raised inflammatory markers (including erythrocyte sedimentation rate). Furthermore, it is necessary to be aware of the risk of acute paraplegia after forceful massage to the back.
From p. 580: In our patient, the cause of the abscess was unclear. But repeated blunt trauma due to chiropractic treatment was possibly responsible. Forceful massage with a hard tool, such as a wooden bar, to the back may cause damage to skin and soft tissue which will result in the formation of a haematoma; this serves as a rich nutrient source for infection. This subsequently induces bacterial invasion into the circulatory system, the development of septicaemia and ultimately abscess formation. 5 In this case, we do not want to over-emphasise the relationship between forceful massage and abscess formation in the back. However, it may play a part in the aetiology of abscess formation.
Filed under: Chiropractic/CAM |