Steven C. Ludwig

Immediate Quadriparesis after Manipulation for Bilateral Cervical Facet Subluxation. A Case Report

Closed reduction of the cervical spine is a commonly performed method of treatment for acute subluxations or dislocations. Although the recommendation has been debated by many authors3,10, a magnetic resonance image or a myelogram of the cervical spine has been advised for evaluation of lesions occupying the canal before closed reduction in patients who are neurologically intact or who have an incomplete injury of the spinal cord. A sudden or gradual worsening of the neurological status of a patient during reduction should alert the physician to the presence of high-grade compression of the spinal cord. Causes of neurological compression include a spinal epidural hematoma, a herniated intervertebral disc, direct compression of the cord due to osseous fracture fragments, edema of the cord, hemorrhage of the cord, and subdural or subarachnoid hemorrhage13. The prevalence of spinal epidural hematoma associated with fracture of the cervical spine was 4 per cent (two of fifty-two) in the study reported by Wortis and Sharp and 1.7 per cent (six of 357) in that reported by Foo and Rossier. Traumatic causes of spinal epidural hematoma include vertebral fracture-dislocation, birth trauma, lumbar puncture, postoperative bleeding, and missile injury1,4,15-17. Spinal epidural hematoma due to trauma has been reported relatively infrequently in the orthopaedic and neurosurgical literature, and it usually results in progressive neurological deficits that necessitate operative decompression8. We report the case of a patient who had bilateral subluxation of the facet of the fifth cervical vertebra on that of the sixth cervical vertebra. The patient was initially neurologically intact and had a gentle closed reduction with slow extension of the cervical spine. Subsequent acute neurological deterioration indicated the need for urgent acquisition of a magnetic resonance image of the cervical spine, …