A Serious Complication of Chiropractic Manipulation in a Patient With Von Willebrand Disease

Von Willebrand disease (VWD) is the most common inherited bleeding disorder and predisposes patients to hemorrhagic complications following trauma or invasive procedures. Chiropractic spinal manipulation is widely used for musculoskeletal pain; however, serious complications have been reported, particularly in patients with underlying coagulopathies.

Iliopsoas hematoma with secondary femoral neuropathy is an uncommon but potentially disabling condition. A team of US doctors present a clinical case highlighting this rare complication following chiropractic manipulation in a patient with VWD and review the relevant literature. They describe the clinical course and follow-up of a 32-year-old female patient with known VWD who developed acute neurological deficits after chiropractic manipulation. Imaging findings were analyzed using radiographs, computed tomography (CT), and magnetic resonance imaging (MRI). Hematoma volume was calculated using the ABC/2 formula, which has been well validated and shows a high correlation with volumes calculated using planimetric techniques.

After chiropractic manipulation, the patient developed severe lumbar and inguinal pain, followed by progressive weakness and sensory impairment of the left lower limb. Imaging revealed a large left iliopsoas hematoma measuring approximately 896 cc, causing femoral nerve compression. Management included coagulation factor replacement, pain control, and interventional radiology-guided drainage, resulting in significant hematoma reduction and neurological improvement. At the six-month follow-up, residual neuropathy and muscle atrophy persisted, although functional recovery was evident.

The uthors concluded that patients with VWD are at high risk for severe hemorrhagic complications even after seemingly minor manipulative therapies. Chiropractic spinal manipulation may precipitate life-threatening or disabling bleeding events in this population. Early recognition, appropriate imaging, correction of the coagulopathy, and multidisciplinary management are crucial to optimize outcomes. This case highlights the importance of patient counseling, risk stratification, and caution when considering alternative therapies in individuals with inherited bleeding disorders.

The list of complications, including fatal ones, after chiropractic manipulations is long – very long. That they can cause iliopsoas hematoma with secondary femoral neuropathy was new to me. The lesson here seems relatively simple: if you have a bleeding abnormality, avoid chiropractic manipulations at all costs!

This, of course, raises an interesting question:

Considering that ~25% of the general population have some sort of clotting abnormality, do chiropractors routinely check whether their pations have normal blood clotting?

Somehow, I doubt it.