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Poster 410: Incomplete Paraplegia After Chiropractic Spinal Manipulation Therapy: A Case Report
PM&R
present with a painful coalescing vesicular rash and possible post herpetic pain syndrome. This virus is morphologically and antigenically identical to the virus that causes chickenpox. It is believed that zoster outbreaks are probably the result of a weakened immune system that fails to halt latent varicella-zoster virus replication. This theory does not always prove true because many patients are found to have healthy intact immune systems. It is uncertain whether factors such as radiation, physical trauma, certain medications, other infections, or stress can also trigger zoster. Conclusions: Herpes zoster expression has not been shown to be associated with physical trauma to the nerve in which the virus resides. This case reveals a loose association between physical trauma to the right C7 foramina and herpatic radiculitis of the exiting nerve. Although it is true, there could be many reasons for the expression of zoster in this case, the expression of zoster along the exact dermatome of the nerve exiting the involved foramina compels us to take a closer look at the diseases association with trauma.
Poster 409 Incomplete Paraplegia Caused by a T7/T8 Subdural Hematoma in a Middle-Aged Man Started on Warfarin for New Onset Atrial Fibrillation: A Case Report. Bradley Benson (University of Missouri, Columbia, MO); Michael Acuff, MD. Disclosures: B. Benson, None. Patients or Programs: 54-year-old man with T6 incomplete tetraplegia. Program Description: Bradley V. Benson, DO, Michael Acuff, MD (Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO). Setting: Acute inpatient rehabilitation hospital. Results: On arrival for rehabilitation, an American Spinal Cord Injury Association (ASIA) examination was performed that classified the patient as a T6 ASIA C incomplete SCI. The patient made minimal functional gains during his 3-week course of rehabilitation, which was complicated by refractory spinal headaches, and he was transferred to internal medicine/cardiology service after re-onset of atrial fibrillation. Discussion: Spinal subdural hemorrhage as an adverse event of anticoagulation with warfarin is very rare, and there is insufficient literature to provide patients with reliable predictions of prognostic outcome after surgical evacuation. Conclusions: Spinal subdural hemorrhage as a cause for SCI is likely to occur in a greater number of patients as warfarin anticoagulation use increases. Medical management, rehabilitation, and prognostic factors need to be further researched to promote improved clinical outcomes for these patients.
Vol. 2, Iss. 9S, 2010
S179
Poster 410 Incomplete Paraplegia After Chiropractic Spinal Manipulation Therapy: A Case Report. Jeffrey A. Beck, MD (University of Wisconsin, Middleton, WI); J George Thomas, MD. Disclosures: J. A. Beck, None. Patients or Programs: A 46-year-old man with a history of low back pain. Program Description: The patient developed severe exacerbation of low back pain and new lower extremity paralysis, without bowel or bladder symptoms after chiropractic spinal manipulation therapy. Setting: University hospital. Results: The patient had bilateral lower extremity weakness (1/5). Sensation to pinprick and light touch was present on the right and absent on the left. The patient had decreased lower extremity tone and hyporeflexia but maintained normal sensation in the genital and perianal region. MRI of the lumbar spine demonstrated a large right L1-2 paracentral disk protrusion, with complete effacement of the thecal sac. The patient was taken to the operating room for emergent L1-L2 laminectomy and microdiskectomy. Discussion: Effectiveness of SMT depends on the competence of practitioners and indication for treatment. Spinal manipulation therapy is relatively safe compared with other therapies. There have been attempts to identify predictors of adverse events from spinal manipulation therapy. First treatment session, more than 1 region treated, use of medications (anesthesia), and female gender were risk factors identified. Conclusions: Serious adverse effects can be directly attributed to chiropractic spinal manipulation therapy. There have been only 20 case reports of herniated disks leading to CES after spinal manipulation therapy between 1925 and 2006, but no case reports demonstrated paraplegia without bowel or bladder dysfunction.
Poster 411 Incomplete Paraplegia Secondary to Thoracic Intradural Plasma Cell Granuloma: A Case Report. Michelle Weiner, DO, MPH (University of Miami, Miami, FL); Diana D. Cardenas, MD, MHA; Kevin L. Dalal, MD; David M. Dechellis, DO. Disclosures: M. Weiner, None. Patients or Programs: A 33-year-old man with a thoracic inflammatory pseudotumor. Program Description: A 33-year-old man presented with a 2-month history of progressive worsening of thoracic back pain and ataxia. Results of a physical examination revealed bilateral lower extremity weakness, hyperreflexia, and impaired sensation distal to T4. MRI revealed severe cord compression at T3-7 with an enhancing intradural extramedullary tumor with a soft tissue paraspinal mass at T8. The
present with a painful coalescing vesicular rash and possible post herpetic pain syndrome. This virus is morphologically and antigenically identical to the virus that causes chickenpox. It is believed that zoster outbreaks are probably the result of a weakened immune system that fails to halt latent varicella-zoster virus replication. This theory does not always prove true because many patients are found to have healthy intact immune systems. It is uncertain whether factors such as radiation, physical trauma, certain medications, other infections, or stress can also trigger zoster. Conclusions: Herpes zoster expression has not been shown to be associated with physical trauma to the nerve in which the virus resides. This case reveals a loose association between physical trauma to the right C7 foramina and herpatic radiculitis of the exiting nerve. Although it is true, there could be many reasons for the expression of zoster in this case, the expression of zoster along the exact dermatome of the nerve exiting the involved foramina compels us to take a closer look at the diseases association with trauma.
Poster 409 Incomplete Paraplegia Caused by a T7/T8 Subdural Hematoma in a Middle-Aged Man Started on Warfarin for New Onset Atrial Fibrillation: A Case Report. Bradley Benson (University of Missouri, Columbia, MO); Michael Acuff, MD. Disclosures: B. Benson, None. Patients or Programs: 54-year-old man with T6 incomplete tetraplegia. Program Description: Bradley V. Benson, DO, Michael Acuff, MD (Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO). Setting: Acute inpatient rehabilitation hospital. Results: On arrival for rehabilitation, an American Spinal Cord Injury Association (ASIA) examination was performed that classified the patient as a T6 ASIA C incomplete SCI. The patient made minimal functional gains during his 3-week course of rehabilitation, which was complicated by refractory spinal headaches, and he was transferred to internal medicine/cardiology service after re-onset of atrial fibrillation. Discussion: Spinal subdural hemorrhage as an adverse event of anticoagulation with warfarin is very rare, and there is insufficient literature to provide patients with reliable predictions of prognostic outcome after surgical evacuation. Conclusions: Spinal subdural hemorrhage as a cause for SCI is likely to occur in a greater number of patients as warfarin anticoagulation use increases. Medical management, rehabilitation, and prognostic factors need to be further researched to promote improved clinical outcomes for these patients.
Vol. 2, Iss. 9S, 2010
S179
Poster 410 Incomplete Paraplegia After Chiropractic Spinal Manipulation Therapy: A Case Report. Jeffrey A. Beck, MD (University of Wisconsin, Middleton, WI); J George Thomas, MD. Disclosures: J. A. Beck, None. Patients or Programs: A 46-year-old man with a history of low back pain. Program Description: The patient developed severe exacerbation of low back pain and new lower extremity paralysis, without bowel or bladder symptoms after chiropractic spinal manipulation therapy. Setting: University hospital. Results: The patient had bilateral lower extremity weakness (1/5). Sensation to pinprick and light touch was present on the right and absent on the left. The patient had decreased lower extremity tone and hyporeflexia but maintained normal sensation in the genital and perianal region. MRI of the lumbar spine demonstrated a large right L1-2 paracentral disk protrusion, with complete effacement of the thecal sac. The patient was taken to the operating room for emergent L1-L2 laminectomy and microdiskectomy. Discussion: Effectiveness of SMT depends on the competence of practitioners and indication for treatment. Spinal manipulation therapy is relatively safe compared with other therapies. There have been attempts to identify predictors of adverse events from spinal manipulation therapy. First treatment session, more than 1 region treated, use of medications (anesthesia), and female gender were risk factors identified. Conclusions: Serious adverse effects can be directly attributed to chiropractic spinal manipulation therapy. There have been only 20 case reports of herniated disks leading to CES after spinal manipulation therapy between 1925 and 2006, but no case reports demonstrated paraplegia without bowel or bladder dysfunction.
Poster 411 Incomplete Paraplegia Secondary to Thoracic Intradural Plasma Cell Granuloma: A Case Report. Michelle Weiner, DO, MPH (University of Miami, Miami, FL); Diana D. Cardenas, MD, MHA; Kevin L. Dalal, MD; David M. Dechellis, DO. Disclosures: M. Weiner, None. Patients or Programs: A 33-year-old man with a thoracic inflammatory pseudotumor. Program Description: A 33-year-old man presented with a 2-month history of progressive worsening of thoracic back pain and ataxia. Results of a physical examination revealed bilateral lower extremity weakness, hyperreflexia, and impaired sensation distal to T4. MRI revealed severe cord compression at T3-7 with an enhancing intradural extramedullary tumor with a soft tissue paraspinal mass at T8. The