背景:颈椎推拿治疗是一种常见的颈部疼痛和僵硬的非侵入性治疗方法,并已在人群中广泛使用。然而,大多数人不注意颈部操作的潜在风险,比如韧带损伤,骨折,和脊髓损伤。硬膜外血肿是一种血液积聚在椎体硬膜外腔的疾病。这种疾病通常是由外伤或医源性手术引起的,并且可能与血液凝固病有关,肿瘤,或退行性脊柱疾病。很少有颈椎推拿引起硬膜外血肿的报道。
方法:我们介绍了一例颈部手术后四肢瘫痪和脊柱休克的患者。入院时对患者进行的体格检查发现颈部压痛和两个上肢的肌肉张力增加。上肢的肤浅感觉消失了,但深深的感觉仍然存在。下肢两侧力量均为0/5。低于T2水平的感觉完全消失。颈部磁共振成像扫描显示C3-T3椎骨的急性后硬膜外血肿。最终,患者接受了紧急血肿清除术,并在随访期间出现部分瘫痪症状改善.
结论:尽管脊柱操作简单,颈部疼痛在普通人群中常见且反复发作,术前需明确患者的基本情况和病史。对于高危患者,颈椎操作应谨慎或禁止。怀疑是血肿,应在早期使用MRI来诊断和定位血肿。
BACKGROUND: Cervical spinal manipulation therapy is a common non-invasive treatment for neck pain and stiffness, and has been widely used in the population. However, most people do not pay attention to the potential risks of neck manipulation, such as ligament damage, fractures, and spinal cord injuries. Epidural hematoma is a disease in which blood accumulates in the epidural space of the vertebral body. This disease is usually caused by trauma or iatrogenic surgery, and may be associated with blood coagulopathies, neoplasms, or degenerative spinal disease.
Reports of epidural hematoma caused by cervical spinal manipulation are rare.
METHODS: We present the
case of a patient with tetraplegia and spinal shock after neck manipulation. A physical examination of the patient on admission found tenderness in the neck and increased muscle tension in both upper limbs. The superficial sensation of the upper limb disappeared, but the deep sensation still remained. The lower extremity had 0/5 power on both sides. The sensation below the T2 level completely disappeared. A cervical magnetic resonance imaging scan showed an acute posterior epidural hematoma from the C3-T3 vertebrae. Ultimately, the patient underwent emergency hematoma removal and showed partial improvement in symptoms of paralysis during follow-up.
CONCLUSIONS: Although spinal manipulation is simple and neck pain is common and recurrent in the general population, the basic condition and disease history of patients should be determined before manipulation. For high-risk patients, caution should be applied for cervical spinal manipulation or it should be prohibited. For a suspected hematoma, MRI should be used at an early stage to diagnose and locate the hematoma.