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Chiropractic Research Review

Chiropractic Manipulation in Patients With Cervical Spinal Cord Compression

While cervical manipulation is considered an effective tool in the management of neck pain, headache and other conditions, less is known about its role in the management of patients with radiculopathy.

Some practitioners feel that cervical manipulation should not be performed in the presence of disk protrusion, while others feel that manipulation is an appropriate treatment. Unfortunately, there is little literature available to guide treating or referring practitioners as to whether, or when, it is safe to use manipulation on these types of patients.

In this study, researchers reviewed a case series of 27 patients (18 female; average age, 44.3 years) presenting with neck and/or arm pain to practitioners at a spine center in Rhode Island. All patients were treated with some form of chiropractic cervical manipulation, and all had the finding of cervical spinal cord encroachment on magnetic resonance imaging. Nineteen patients were treated with high-velocity, low-amplitude thrust manipulation; nine patients were treated with low-velocity muscle energy technique; and one patient was treated with both methods.

Results: Patient-rated subjective improvement at the last follow-up examination was 70 percent. From baseline to the last follow-up examination, mean improvements ranged from 3.9 points on a numerical pain rating scale to 23.7 points using the Bournemouth Neck Disability Questionnaire. In three patients, there was increased pain after manipulation lasting from 1-4 days. In no patient did any increased pain post-treatment last more than four days. In addition, no new neurologic symptoms or signs were observed, and no major complications were reported in any of the patients.

Conclusion: "It would appear from these data that the finding of cervical spinal cord encroachment on MRI should not be considered an absolute contraindication to cervical manipulation. Even in patients with mild myelopathic signs, this treatment may be provided in cases. However, because the finding of cord encroachment does not necessarily indicate cord pathology, it cannot be said that all cases of cord encroachment can be treated safely. ... Because spinal cord and nerve root-related complications have been reported after cervical manipulation, appropriate clinical reasoning must be used regarding the presence of pathologic changes in the spinal cord before deciding to use cervical manipulation."

Murphy DR, Hurwitz EL, Gregory AA. Manipulation in the presence of cervical spinal cord compression: a case series. Journal of Manipulative and Physiological Therapeutics 2006;29:236-244.

Chiropractic Research Review

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