MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Upper spinal manipulation, the signature-treatment of many chiropractors is by no means free of serious risks. Most chiropractors negate this, but can any reasonable person deny it? Neurosurgeons from New York have just published an interesting case-report in this context:

A 45 year old male with presented to his internist with a two-week history of right sided neck pain and tenderness, accompanied by tingling in the hand. The internists’ neurological examination revealed nothing abnormal, except for a decreased range of motion of the right arm. He referred the patient to a chiropractor who performed plain X-rays which apparently showed “mild spasm” (how anyone can see spasm on an X-ray is beyond me!). No magnetic resonance imaging study was done.

The chiropractor proceeded manipulating the patient’s neck on two successive days. By the morning of the third visit, the patient reported extreme pain and difficulty walking. Without performing a new neurological examination or obtaining a magnetic resonance study, the chiropractor manipulated the patient’s neck for a third time.

Thereafter, the patient immediately became quadriplegic. Despite undergoing an emergency C5 C6 anterior cervical diskectomy/fusion to address a massive disc found on the magnetic resonance scan, the patient remained quadriplegic. There seemed to be very little doubt that the quadriplegia was caused by the chiropractic spinal manipulation.

The authors of this report also argue that a major point of negligence in this case was the failure of both the referring internist and chiropractor to order a magnetic resonance study of the cervical spine prior to the chiropractic manipulations. In his defence, the internist claimed that there was no known report of permanent quadriplegia resulting from neck manipulation in any medical journal, article or book, or in any literature of any kind or on the internet. Even the quickest of literature searches discloses this assumption to be wrong. The first such case seems to have been published as early as 1957. Since then, numerous similar reports have been documented in the medical literature.

The internist furthermore claimed that the risk of this injury must be vanishingly small given the large numbers of manipulations performed annually. As we have pointed out repeatedly, this argument is pure speculation; under-reporting of such cases is huge, and therefore exact incidence figures are anybody’s guess.

The patient sued both the internist and the chiropractor, and the total amount of the verdict was $14,596,000.00 the internist’s liability was 5% ($759,181.65).

22 Responses to Another wheelchair filled with the help of a chiropractor

  • must have been a rubbish neurological exam if a patient presented with P&N and yet the examiner recorded nothing abnormal.

    what’s wrong with believing the patient and recording where they tell you sensation is altered?

  • I think it’s worth highlighting some of the other similar quadriplegia reports related to chiropractic which have been documented in the medical literature:

    1965 Godlewski S. Assises Med 1965; 23 (2):81-92 Practitioner: Chiropractor. Patient: female. Age 66. Diagnostic des thromboses vertebro-basilaire QUADRIPLEGIA

    1980 Schellhas KP, Latchaw RE, Wendling LR, Gold LHA. Vertebrobasilar
    injuries following cervical manipulation. J.A.M.A. 1980; 244 (13): 1450-3. Practitioner: Chiropractor Patient: female 36. Basilar artery occlusion. SPASATIC QUADRIPLEGIA. LOCK-IN SYNDROME.

    1993 Neck911 case file Practitioner: Chiropractor Male age 39. QUADRAPLEGIC

    1994 Bridges R. Trial or settlement. Circumstances that prompt the decision.
    J Chiropr 1994; 31 (I I): 44-7. Chiropractor. Patient: female. QUADRAPLEGIC. LOCKED IN SYNDROME.

    1994 Neck911 data R.D. Ontario CANADA Practitioner: Chiropractor Patient: female age 30. QUADRAPLEGIC

    1967 Sparks, Sandy California Practitioner: Chiropractor. Patient: female under 40 years. QUADRAPLEGIC

    2000 CANADA Norris JW Beletsky V. Sudden neck movement and cervical artery dissection. REVIEW OF 21 CASES All cases are chiropractic. Specific breakdown of age and sex not available A) Vertebral artery dissections B) Carotid artery dissections. A) GENERALLY CAUSED ATAXIAS AND QUADRIPARESIS. B) GENERALLY CAUSE HEMIPARESIS. APHASIA

    Dozens more chiropractic injury reports also listed here (including tetrapelgia and Locked-In Syndrome):
    http://web.archive.org/web/20060924185308/http://www.chirovictims.org.uk/images/Detailed%20database%20high%20neck%20manipulation%20reports.doc

    And here are two more:

    Quadriplegia after chiropractic manipulation in an infant with congenital torticollis caused by a spinal cord astrocytoma:
    An infant with congenital torticollis (twisted neck) underwent chiropractic manipulation, and within a few hours had respiratory insufficiency, seizures, and quadriplegia. Journal of Pediatrics (February 1992)
    http://www.ncbi.nlm.nih.gov/pubmed/1735825?dopt=Abstract

    Catastrophic complication of chiropractic manipulation: A report of quadriparesis: “Spinal manipulative therapy is a frequently applied therapy for back and neck pain. Carotid and vertebral artery trauma, cerebellar and brainstem stroke, fracture of odontoid process, and atlantoaxial dislocation due to chiropractic manipulation have been reported in the literature. We report an occurrence of quadriparesis after chiropractic manipulation…We believe that the manipulation in this patient led to the para central C6-C7 disc protrusion and subsequent quadriparesis due to temporal association with the maneuver, clinical plausibility, and lack of alternate explanation. Although the absolute risk due to neck manipulation is small, the risk-to-benefit ratio of manipulation for neck pain and prolapsed disc is unacceptably high.” American Journal of Medicine (November 2009)
    http://www.amjmed.com/article/S0002-9343(09)00583-X/fulltext

    One victim has even written a book about his chiropractic quadraplegia injury using a mouth/headstick:

    Locked In: Chiropractic adjustment gone wrong
    For forty-one year old Scott Tatro, owner of a successful excavation business, the summer of 2000 was typically busy until pain and soreness brought him to see a chiropractor, expecting to be back at work the next day. He would never return, instead relegated to a completely immobile position for months due to a brain stem stroke and resultant Locked-in Syndrome that occurred during treatment. His book, Locked In, completely compiled by using a mouth/headstick to type, details the unimaginable difficulties the condition presents and the heroic courage necessary to function at the most minimal level of movement.
    https://scottslockedin.com/Home_Page.html

    Readers should bear in mind that the above reports have made it to publication despite chiropractors having either no adverse event reporting systems, or extremely unreliable ones. The true frequency and severity of complications resulting from chiropractic interventions remains unknown.

  • Stephen Barrett, M.D., Founder of Quackwatch, has written an article about chiropractor-induced stroke: Here’s an excerpt:

    “Stroke from chiropractic neck manipulation occurs when an artery to the brain ruptures or becomes blocked by a clot as a result of being stretched. The injury often results from extreme rotation in which the practitioner’s hands are placed on the patient’s head in order to rotate the cervical spine by rotating the head… The vertebral artery … is vulnerable because it winds around the topmost cervical vertebra (atlas) to enter the skull, so that any abrupt rotation may stretch the artery and tear its delicate lining. The anatomical problem is illustrated on page 7 of The Chiropractic Report, July 1999. A blood clot formed over the injured area may subsequently be dislodged and block a smaller artery that supplies the brain. Less frequently, the vessel may be blocked by blood that collects in the vessel wall at the site of the dissection…

    “Chiropractors would like you to believe that the incidence of stroke following neck manipulation is extremely small. Speculations exist that the risk of a serious complication due to neck manipulation are somewhere between one in 40,000 and one in 10 million manipulations. No one really knows, however, because (a) there has been little systematic study of its frequency; (b) the largest malpractice insurers won’t reveal how many cases they know about; and (c) a large majority of cases that medical doctors see are not reported in scientific journals.”

  • And classical western medics or surgeons have never of course killed or seriously hurt anyone?!?!?

    Of course they have, it happens every day!

    I’m unconvinced, you get good doctors you get not so good doctors, the same applies with Chiropractors and you also get circumstances where the outcome could never have been foreseen..

    • I think the whole point of this case report was that the outcome could have been foreseen – provided the right sort of investigation would have been done. at least that is what the jury thought and the judge ruled.

      • It is appalling, nonetheless, that the poor man was referred by an MD–such referrals need to be banned. It’s bad enough that here in the US, many states require insurance to pay chiros. How many people have to suffer before someone tells the chiros to stop pretending to be doctors. State licensing of alternative practitioners is running amok with no science input–just legislators making it legal for anyone with a “belief” to pass as a medical professional.

        • The DC (Chiropractic ) was to blame not the Chiropractic profession for this. The MD was not to blame at all.

          Exactly like Johnny Green said, you get good Doctors and bad as you get bad people in ANY field they work in.

          I’ve been to some bad GP’s, I’d actually go as far as to say MOST GP’s (General Practice Medical Doctor) and MOST DC’s (Doctors of Chiropractic) also. Where there is money it attracts people for the WRONG reasons.

          When you get a hold of a GOOD one (in any of the mentioned fields) KEEP them as they are very rare.

          Hell the same could be said about a tradesman and the evidence is there to back it up!

          The Chiropractor SHOULD have done FULL testing after initial consultation, ESPECIALLY after symptoms got worse. This falls under exactly the same thing I’ve experienced with MD’s first hand, symptoms have got worse and the response? “Just up the dose” or “Go home and take it easy, nothing is wrong”

          Hell they did the same thing at the emergency hospital and my other almost died from a Ectopic Pregnancy.

          My point is ALL health professionals need to have a duty of care. This is NOT the professions fault but the individual.

          I think Johnny Greens main point was every time a Chiropractor does something wrong it makes headlines but if a Medical Doctor kills someone in surgery it doesn’t even get a mention and I couldn’t agree more.

          • Chiropractors are easy to blame be ause thte treatment is physical but MDs are not because their treatments are chemical(hard to prove a problem when it’s internal).

    • Johny Green said:

      And classical western medics or surgeons have never of course killed or seriously hurt anyone?!?!?

      Of course they have, it happens every day!

      What are you implying? That because other patients die, we shouldn’t concern ourselves by a few deaths at the hands of a chiro?

  • Many managed care systems would not have authorized a cervical MRI for a patient with new onset pain and a normal neuro exam. Few state Medicaid systems would do so. Incidents like these will unfortunately become more common.

  • @Johny Green:
    There is no such thing as “Western Medicine”. There is only “medicine” – proven procedures that have undergone rigorous peer review and have changed over time as new evidence and facts come to light.

    Everything else is quackery and BS.

  • @Dave
    And there is only one Spanish language and one version of English ,right?

    • @William:
      What part of “proven procedures that have undergone rigorous peer review and have changed over time as new evidence and facts come to light” does language have? Medicine doesn’t have dialects. Analogy fail.

  • Where are the posts that slam Physical Therapists and Osteopaths for “manipulating” the neck – or for that case Medical Doctors who learn manipulation at a weekend seminar? Is it because of the word subluxation? Or is it because it was a chiropractor who performed the manipulation? You are aware that other professions in the medical model use manipulations to the cervical spine on a regular basis. They even publish peer reviewed research on it.

    Let me get this straight – remove those two words and then the procedure is no longer dangerous? I’m confused.

  • Your opinion on this Dr.Ernst ?

    http://link.springer.com/article/10.1186/1746-1340-14-16#page-1

    How many strokes by barbers are included in the literature?

  • Thank you so much to everyone that contributed to the comments!

  • Reading through the full case here:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717529/
    The history is full of red flags that both the internist and chiropractor seem to overlook, especially in 2008. Additionally, the chiropractor failed to terminate care after the second visit, and was slow to call for an ambulance after the third visit. So, as stated in the court case there was negligence on the part of the chiropractor.

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