Thoracic Disk Herniation Associated With Chiropractic Spinal Manipulation

TO THE EDITOR. —Chiropractic spinal manipulation has been associated with numerous neurologic complications, including brain-stem infarction,1 cervical spinal cord injury,2 and cauda equina syndrome.3-5 We describe a case of thoracic intervertebral disk herniation with resultant myelopathy following spinal manipulation. REPORT OF A CASE. —This previously healthy 55-year-old man visited a chiropractor with a complaint of low back pain. Aggressive rotatory and hyperextensional manipulation of the entire spine was performed, immediately following which he noted the onset of numbness and paresthesias in both feet. His sensory complaints progressed and, five days later, he presented with bandlike pain in the upper thoracic region and increased numbness to approximately the level of the umbilicus. Physical examination showed mild left leg weakness and a wide-based, unsteady gait. Deep-tendon reflexes in the lower extremities were brisk and symmetric. Babinski's sign was present on the left side and equivocal on the right side.