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The Journal of Bone and Joint Surgery 79:587-90 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Immediate Quadriparesis after Manipulation for Bilateral Cervical Facet Subluxation. A Case Report*

STEVEN C. LUDWIG, M.D.{dagger}, ALEXANDER R. VACCARO, M.D.{dagger}, RICHARD A. BALDERSTON, M.D.{dagger} and JEROME M. COTLER, M.D.{dagger}, PHILADELPHIA, PENNSYLVANIA

Investigation performed at the Department of Orthopaedic Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia


   Introduction
 
Closed reduction of the cervical spine is a commonly performed method of treatment for acute subluxations or dislocations. Although the recommendation has been debated by many authors3,10, a magnetic resonance image or a myelogram of the cervical spine has been advised for evaluation of lesions occupying the canal before closed reduction in patients who are neurologically intact or who have an incomplete injury of the spinal cord. A sudden or gradual worsening of the neurological status of a patient during reduction should alert the physician to the presence of high-grade compression of the spinal cord.

Causes of neurological compression include a spinal epidural hematoma, a herniated intervertebral disc, direct compression of the cord due to osseous fracture fragments, edema of the cord, hemorrhage of the cord, and subdural or subarachnoid hemorrhage13.

The prevalence of spinal epidural hematoma associated with fracture of the cervical spine was 4 per cent . . . [Full Text of this Article]


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