A case report of a U-type sacral fracture, or spinopelvic dissociation, resulting from chiropractic manipulation has recently been published. It presents the case of a 74-year-old male patient who sustained a U-type sacral fracture after drop-table chiropractic manipulation.
The drop table chiropractic technique is claimed by chiropractors to involve lesser brute force for spinal manipulation than traditional chiropractic care. It involves low-velocity movement and less spinal manoeuvring on the specific area of injury. It is said to be particularly beneficial for adjusting the pelvis or sacroiliac joints. Furthermore, this is, according to chiros, one of the only methods that can adjust spondylolisthesis. In fact, the evidence that it is effective for anything other that boosting the chiros’ income is more than thin, while there is at least one tragic report that it can be lethal.
The recent case of a spinopelvic dissociation demonstrates that chiropractic manipulative therapy involving the commonly used drop-table can cause severe injury. The patient’s course was complicated by a delay in diagnosis and a prolonged hospital stay. Orthopaedic surgeons should have a high degree of suspicion for spinopelvic dissociation in the setting of bilateral sacral fractures. One year after injury, with conservative management, the patient returned to baseline function with mild residual neuropathy.
Spinopelvic dissociation is a rare injury associated with 2% to 3% of transverse sacral fractures and 3% of sacral fractures associated with pelvic ring injuries. When spinopelvic dissociation is expediently identified and treated appropriately, patient outcomes can be maximized, highlighting the importance of early diagnosis and treatment. Because of its rarity and complexity, there remains a paucity of high-level evidence-based guidance on treating this complex issue. Most cases are caused by a fall from heights, followed by road accidents. Many patients show neurologic impairment at initial presentation, which often improves after surgery, the treatment of choice.
2 Responses to A Case Report of Spinopelvic Dissociation After Chiropractic Adjustment
Leave a Reply
This site uses Akismet to reduce spam. Learn how your comment data is processed.
The ‘one tragic report’ concerned Mr John Lawler – and Prof’s initial post was written before the inquest.
Mr Lawler had ankylosing spondylitis, surely a contraindication to any manipulation;
He did not give informed consent;
He assumed that because the chiropractor styled herself ‘Dr’, she was indeed a medical doctor – which she was not and which she did not explain;
The ‘expert witness’ at the inquest was a chiropractor, not a spinal surgeon or rheumatologist, or any kind of registered medical practitioner;
The ‘expert’ opined that the drop table technique was appropriate in Mr Lawler’s case.
Sigh.
Caveat emptor.
Thanks Richard. You voice of reason always hits it home.
I’m currently dealing with some lower back issues and rest assure, I will never darken the doors of any Chiropractors office. Even with their fancy drop table!
What a continuing gong show of gimmicks.