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Chiropractic Research Review

Posttraumatic Syringomyelia and Spinal Manipulation

This paper was published in response to a previously published case report that included the recommendation that posttraumatic syringomyelia (PTS) be considered "a contraindication to forceful manipulation in the involved area." This particular claim was made based upon reasoning associated with a single patient case.

The current paper asserts the potential benefits of manipulation for patients with PTS who experienced mechanical spine pain. In one of the cases, the PTS was asymptomatic; in the other, PTS was symptomatic and had been treated surgically with shunt implantation. Surgical treatment in this case did not alter the pathophysiology of the disorder, but simply shunted cerebrospinal fluid from the syrinx cavity to the subarachnoid space. Both patients were treated successfully with high-velocity, low-amplitude thrust manipulation to the area of the syrinx.

The author mentions that, because syrinx progression may relate to increased intramedullary pressure, avoiding flexion during treatment may decrease the likelihood of complications related to this condition. Additionally, the author points out that if the patients condition worsens, this may indicate the natural progression of PTS. If the patient is receiving adjustments to the spine and begins to deteriorate, the natural progression of the disease and the spinal manipulation would have to be suspected as potential contributors.

Conclusions: This paper suggests that "the presence of a syrinx cavity should not, in and of itself, constitute a contraindication to HVLA manipulation."

As the author notes, the interpretations of this research are based upon on two patient cases, in response to another doctor's experience with one case. A much greater amount of evidence is necessary before firm conclusions can be drawn regarding the role of spinal adjustments in PTS patients.

Murphy DR. Post-traumatic syringomyelia: absolute contraindication to manipulation? A report of two cases. Journal of the Neuromusculoskeletal System, Summer 2000:8(2), pp54-58. Reprints: (800) 342-0454

Chiropractic Research Review

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