This case involves a patient who went to a chiropractor for a neck adjustment. The patient had seen this chiropractor for adjustments in past years with no problems. During the visit, the chiropractor manipulated the patient’s neck, which caused an audible cracking sound. The patient was alarmed, but the chiropractor assured her that she should not be concerned. Over the next several weeks, the patient developed severe headaches and presented to the hospital for an MRI. The MRI showed swelling of the brain membrane and an MRI of the spine showed bone spurs and degenerative spinal stenosis. An expert in chiropractic medicine was sought to determine whether the treating chiropractor should have conducted a more detailed exam before adjusting the patient.
Question(s) For Expert Witness
- 1. How often do you perform manipulations on your patients?
- 2. What are the guidelines for performing a manipulation on a patient with spinal stenosis?
Expert Witness Response E-044178
I typically perform manipulations about 4-5 times on each patient I see, and I see about 30 -40 patients per day. I have been in practice 30 years. Manipulation is generally contraindicated in patients with suspected spinal infection but is not necessarily contraindicated for other inflammatory spinal conditions. I see patients and treat their degenerative joint disease with manipulation every day. The guidelines for performing manipulation on a patient with spondylitis depend on the nature of the condition. The DC would be expected to take a thorough history and perform a relevant examination. If there was a history of serious prior medical conditions (tumors, history of spinal infection or similar) then manipulation might be relatively contraindicated until further clarification was obtained. Certainly, a basic palpatory evaluation, as well as range of motion, motor, reflex and sensory testing, would be typical. I have served as an expert on cases regarding unexpected negative consequences of cervical manipulation.