{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:32:54Z","timestamp":1769725974391,"version":"3.49.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,8,11]]},"abstract":"\n BACKGROUND<\/jats:title>\n Traumatic spinal cord injury is a devastating condition resulting in significant functional impairment. It is known that spinal manipulation therapy, often used as complementary treatment for presumed muscular neck pain, may rarely precipitate spinal cord compression and injury in patients with undiagnosed cervical canal stenosis.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors report the case of a 68-year-old woman who presented to the emergency department with right scapular-paravertebral pain and right upper limb paresthesia, initially attributed to muscular causes without imaging. Spinal manipulation therapy was administered in the emergency department, causing sudden bilateral lower limb sensory loss and right lower limb motor deficit. No imaging or neurosurgical consultation was undertaken until she returned the next day with progressive weakness, hypoesthesia, and burning dysesthesia. Subsequently, MRI revealed a large acute C6\u20137 disc extrusion with underlying chronic multilevel stenosis, requiring anterior fusion and posterior decompression. Postoperatively, she partially improved, but a partial motor deficit, lower limb hypoesthesia, and neuropathic pain persisted.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case highlights the importance of thorough clinical and radiological assessment prior to administering spinal manipulation in the cervical spine, particularly in patients with signs of sensory or motor dysfunction. Torticollis and muscular contractions in the limbs may be presenting signs of cervical stenosis and degenerative cervical myelopathy, thus requiring further neurological investigation before patients are considered for spinal manipulation therapy.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25304<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25304","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T23:43:48Z","timestamp":1754955828000},"source":"Crossref","is-referenced-by-count":0,"title":["Sudden spinal cord injury after cervicothoracic manipulation therapy: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3895-5158","authenticated-orcid":true,"given":"Simone","family":"Grann\u00f2","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"Lav\u00e9","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Granit","family":"Molliqaj","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianpaolo","family":"Jannelli","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Schaller","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Tessitore","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4965-3059","authenticated-orcid":true,"given":"Aria","family":"Nouri","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"bib1","series-title":"Spine","first-page":"E675","article-title":"Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis","volume":"40","author":"Nouri","year":"2015","unstructured":"Nouri ATetreault LSingh AKaradimas SKFehlings MG.Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine. 2015;40(12):E675-E693."},{"issue":"1 suppl","key":"bib2","series-title":"Global Spine J","first-page":"39S","article-title":"Degenerative cervical myelopathy: development and natural history [AO Spine RECODE-DCM Research Priority Number 2]","volume":"12","author":"Nouri","year":"2022","unstructured":"Nouri ATessitore EMolliqaj GDegenerative cervical myelopathy: development and natural history [AO Spine RECODE-DCM Research Priority Number 2]. Global Spine J. 2022;12(1 suppl):39S-54S."},{"key":"bib3","series-title":"BMJ","first-page":"k186","article-title":"Degenerative cervical myelopathy","volume":"360","author":"Davies","year":"2018","unstructured":"Davies BMMowforth ODSmith EKKotter MR.Degenerative cervical myelopathy. BMJ. 2018;360:k186."},{"issue":"2","key":"bib4","series-title":"JBJS Am","first-page":"376","article-title":"Prevalence of cervical spine stenosis. Anatomic study in cadavers","volume":"89","author":"Lee","year":"2007","unstructured":"Lee MJCassinelli EHRiew KD.Prevalence of cervical spine stenosis. Anatomic study in cadavers. JBJS Am. 2007;89(2):376-380."},{"issue":"20","key":"bib5","series-title":"Dtsch \u00c4rztebl Int","article-title":"Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment","volume":"105","author":"Meyer","year":"2008","unstructured":"Meyer FB\u00f6rm WThom\u00e9 C.Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch \u00c4rztebl Int. 2008;105(20):366-372."},{"key":"bib6","series-title":"Handb Clin Neurol","first-page":"541","article-title":"Spinal stenosis","volume":"119","author":"Melancia","year":"2014","unstructured":"Melancia JLFrancisco AFAntunes JL.Spinal stenosis. Handb Clin Neurol. 2014;119:541-549."},{"key":"bib7","series-title":"J Clin Neurosci","first-page":"53","article-title":"The prevalence of degenerative cervical myelopathy-related pathologies on magnetic resonance imaging in healthy\/asymptomatic individuals: a meta-analysis of published studies and comparison to a symptomatic cohort","volume":"99","author":"Banerjee","year":"2022","unstructured":"Banerjee AMowforth ODNouri AThe prevalence of degenerative cervical myelopathy-related pathologies on magnetic resonance imaging in healthy\/asymptomatic individuals: a meta-analysis of published studies and comparison to a symptomatic cohort. J Clin Neurosci. 2022;99:53-61."},{"key":"bib8","series-title":"World Neurosurg","first-page":"112","article-title":"Cervical cord-canal mismatch: a new method for identifying predisposition to spinal cord injury","volume":"108","author":"Nouri","year":"2017","unstructured":"Nouri AMontejo JSun XCervical cord-canal mismatch: a new method for identifying predisposition to spinal cord injury. World Neurosurg. 2017;108:112-117."},{"issue":"6508","key":"bib9","series-title":"Br Med J (Clin Res Ed)","first-page":"1540","article-title":"Osteopathic manipulation resulting in damage to spinal cord","volume":"291","author":"Davis","year":"1985","unstructured":"Davis C.Osteopathic manipulation resulting in damage to spinal cord. Br Med J (Clin Res Ed). 1985;291(6508):1540-1541."},{"issue":"8","key":"bib10","series-title":"Spinal Cord","first-page":"488","article-title":"Radiculomedullary complications of cervical spinal manipulation","volume":"34","author":"Padua","year":"1996","unstructured":"Padua LPadua RLoMonaco MTonali PA.Radiculomedullary complications of cervical spinal manipulation. Spinal Cord. 1996;34(8):488-492."},{"issue":"6","key":"bib11","series-title":"Neurosurg Focus","first-page":"ecp1","article-title":"Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice","volume":"13","author":"Malone","year":"2002","unstructured":"Malone DGBaldwin NGTomecek FJComplications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice. Neurosurg Focus. 2002;13(6):ecp1."},{"issue":"8","key":"bib12","series-title":"Isr Med Assoc J","first-page":"542","article-title":"Acute presentation of cervical myelopathy following manipulation therapy","volume":"21","author":"Salame","year":"2019","unstructured":"Salame KGrundshtein ARegev GKhashan MLador RLidar Z.Acute presentation of cervical myelopathy following manipulation therapy. Isr Med Assoc J. 2019;21(8):542-545."},{"issue":"10","key":"bib13","series-title":"Cureus","first-page":"e30508","article-title":"Identification of degenerative cervical myelopathy in the chiropractic office: case report and a review of the literature","volume":"14","author":"Trager","year":"2022","unstructured":"Trager RJSmith GALabak CMBattaglia PJDusek JA.Identification of degenerative cervical myelopathy in the chiropractic office: case report and a review of the literature. Cureus. 2022;14(10):e30508."},{"issue":"6","key":"bib14","series-title":"J Neurotrauma","first-page":"862","article-title":"Extent of spinal cord decompression in motor complete (American Spinal Injury Association Impairment Scale Grades A and B) traumatic spinal cord injury patients: post-operative magnetic resonance imaging analysis of standard operative approaches","volume":"36","author":"Aarabi","year":"2019","unstructured":"Aarabi BOlexa JChryssikos TExtent of spinal cord decompression in motor complete (American Spinal Injury Association Impairment Scale Grades A and B) traumatic spinal cord injury patients: post-operative magnetic resonance imaging analysis of standard operative approaches. J Neurotrauma. 2019;36(6):862-876."},{"issue":"3 suppl","key":"bib15","series-title":"Glob Spine J","first-page":"187S","article-title":"A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on hemodynamic management","volume":"14","author":"Kwon","year":"2024","unstructured":"Kwon BKTetreault LAMartin ARA clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on hemodynamic management. Glob Spine J. 2024;14(3 suppl):187S-211S."},{"issue":"12","key":"bib1","series-title":"Spine","first-page":"E675","article-title":"Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis","volume":"40","author":"Nouri","year":"2015","unstructured":"Nouri ATetreault LSingh AKaradimas SKFehlings MG.Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. 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Anatomic study in cadavers","volume":"89","author":"Lee","year":"2007","unstructured":"Lee MJCassinelli EHRiew KD.Prevalence of cervical spine stenosis. Anatomic study in cadavers. JBJS Am. 2007;89(2):376-380."},{"issue":"20","key":"bib5","series-title":"Dtsch \u00c4rztebl Int","article-title":"Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment","volume":"105","author":"Meyer","year":"2008","unstructured":"Meyer FB\u00f6rm WThom\u00e9 C.Degenerative cervical spinal stenosis: current strategies in diagnosis and treatment. Dtsch \u00c4rztebl Int. 2008;105(20):366-372."},{"key":"bib6","series-title":"Handb Clin Neurol","first-page":"541","article-title":"Spinal stenosis","volume":"119","author":"Melancia","year":"2014","unstructured":"Melancia JLFrancisco AFAntunes JL.Spinal stenosis. Handb Clin Neurol. 2014;119:541-549."},{"key":"bib7","series-title":"J Clin Neurosci","first-page":"53","article-title":"The prevalence of degenerative cervical myelopathy-related pathologies on magnetic resonance imaging in healthy\/asymptomatic individuals: a meta-analysis of published studies and comparison to a symptomatic cohort","volume":"99","author":"Banerjee","year":"2022","unstructured":"Banerjee AMowforth ODNouri AThe prevalence of degenerative cervical myelopathy-related pathologies on magnetic resonance imaging in healthy\/asymptomatic individuals: a meta-analysis of published studies and comparison to a symptomatic cohort. J Clin Neurosci. 2022;99:53-61."},{"key":"bib8","series-title":"World Neurosurg","first-page":"112","article-title":"Cervical cord-canal mismatch: a new method for identifying predisposition to spinal cord injury","volume":"108","author":"Nouri","year":"2017","unstructured":"Nouri AMontejo JSun XCervical cord-canal mismatch: a new method for identifying predisposition to spinal cord injury. World Neurosurg. 2017;108:112-117."},{"issue":"6508","key":"bib9","series-title":"Br Med J (Clin Res Ed)","first-page":"1540","article-title":"Osteopathic manipulation resulting in damage to spinal cord","volume":"291","author":"Davis","year":"1985","unstructured":"Davis C.Osteopathic manipulation resulting in damage to spinal cord. Br Med J (Clin Res Ed). 1985;291(6508):1540-1541."},{"issue":"8","key":"bib10","series-title":"Spinal Cord","first-page":"488","article-title":"Radiculomedullary complications of cervical spinal manipulation","volume":"34","author":"Padua","year":"1996","unstructured":"Padua LPadua RLoMonaco MTonali PA.Radiculomedullary complications of cervical spinal manipulation. Spinal Cord. 1996;34(8):488-492."},{"issue":"6","key":"bib11","series-title":"Neurosurg Focus","first-page":"ecp1","article-title":"Complications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice","volume":"13","author":"Malone","year":"2002","unstructured":"Malone DGBaldwin NGTomecek FJComplications of cervical spine manipulation therapy: 5-year retrospective study in a single-group practice. Neurosurg Focus. 2002;13(6):ecp1."},{"issue":"8","key":"bib12","series-title":"Isr Med Assoc J","first-page":"542","article-title":"Acute presentation of cervical myelopathy following manipulation therapy","volume":"21","author":"Salame","year":"2019","unstructured":"Salame KGrundshtein ARegev GKhashan MLador RLidar Z.Acute presentation of cervical myelopathy following manipulation therapy. Isr Med Assoc J. 2019;21(8):542-545."},{"issue":"10","key":"bib13","series-title":"Cureus","first-page":"e30508","article-title":"Identification of degenerative cervical myelopathy in the chiropractic office: case report and a review of the literature","volume":"14","author":"Trager","year":"2022","unstructured":"Trager RJSmith GALabak CMBattaglia PJDusek JA.Identification of degenerative cervical myelopathy in the chiropractic office: case report and a review of the literature. Cureus. 2022;14(10):e30508."},{"issue":"6","key":"bib14","series-title":"J Neurotrauma","first-page":"862","article-title":"Extent of spinal cord decompression in motor complete (American Spinal Injury Association Impairment Scale Grades A and B) traumatic spinal cord injury patients: post-operative magnetic resonance imaging analysis of standard operative approaches","volume":"36","author":"Aarabi","year":"2019","unstructured":"Aarabi BOlexa JChryssikos TExtent of spinal cord decompression in motor complete (American Spinal Injury Association Impairment Scale Grades A and B) traumatic spinal cord injury patients: post-operative magnetic resonance imaging analysis of standard operative approaches. J Neurotrauma. 2019;36(6):862-876."},{"issue":"3 suppl","key":"bib15","series-title":"Glob Spine J","first-page":"187S","article-title":"A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on hemodynamic management","volume":"14","author":"Kwon","year":"2024","unstructured":"Kwon BKTetreault LAMartin ARA clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on hemodynamic management. Glob Spine J. 2024;14(3 suppl):187S-211S."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/6\/article-CASE25304.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/6\/article-CASE25304.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/6\/article-CASE25304.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:09:10Z","timestamp":1769684950000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/6\/article-CASE25304.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,11]]},"references-count":30,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/case25304","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,11]]}}}