Objective: Spinal manipulation therapy is widely used for the treatment of lower-back pain. Serious complications to spinal manipulation are most often seen in the cervical region. We report the first case of a lumbar epidural hematoma after chiropractic manipulation.
Clinical presentation: A 77-year-old man with a long history of lower-back pain underwent chiropractic manipulation of the lower spine. He was receiving anticoagulation therapy as a result of chronic atrial fibrillation. After a manipulation session, he developed partial cauda equina syndrome with lower extremity paresis and urinary retention. Computed tomographic and magnetic resonance imaging scans showed an epidural hematoma at the L3 level.
Intervention and technique: We performed surgical evacuation of the hematoma through laminectomy of L3 and L4. During the follow-up period, his motor deficits improved, but the bladder dysfunction remained.
Conclusion: This is the first case report of a lumbar epidural hematoma after chiropractic manipulation. Even rare complications after chiropractic manipulation of the spine should be weighed against potential benefits of such treatment. Caution should be shown in patients receiving antithrombotic therapy.