OBJECTIVE: To present the first case of spinal cord injury from high jump and the first pilot case of spinal manipulation for post-traumatic myelopathy.
CLINICAL FEATURES: An 11-yr-old tetraplegic boy was admitted to the hospital, where he had a thorough neurological examination, including myelogram, EEG and skull and spinal X rays, with normal findings. The author revealed subtle subluxations on plain X-ray films. Triceps hyperreflexia was detected bilaterally. Bilateral patella and ankle clonus with hyperreflexia, basic and excess spasticity, and bilateral extensor plantar responses were noted in the lower limbs. A clinical diagnosis of early post-traumatic incomplete spastic tetraplegia below C7 was made.
INTERVENTION AND OUTCOME: He did not respond to 3 months of orthodox conservative hospital management, including steroid therapy. Spinal manipulation of the lower cervical and upper thoracic spine was performed in a private chiropractic clinic for 2 wk. He apparently recovered after 3 months of spinal manipulation. On recent examination, he has virtually completely recovered. He still suffers from hand muscle atrophy, hyperreflexia of the triceps and ankle reflex and bilateral positive Babinski reflex; ankle and patellar clonus are almost absent.
CONCLUSIONS: The early response and long-term (9-yr follow-up) benefits of spinal manipulation to the early delayed traumatic myelopathy of this patient suggest spinal cord ischemia as its pathophysiology. Mechanisms of post-traumatic myelopathy are postulated. Biomechanical mechanisms of spinal manipulation for neurological recovery of post-traumatic myelopathy and/or radiculopathy are advanced. Further pilot spinal manipulation by experienced chiropractors after adequate anti-edematous (steroid) therapy is recommended for selected patients with post-traumatic myelopathy and/or radiculopathy, especially in a multidisciplinary spinal injury unit.
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