Answers to Questions about Chiropractic:
Can Violent Spinal Manipulation
Cause a Spinal Cord Syrinx?

Samuel Homola, D.C.

QuestionI have gone to a chiropractor for about two years, off and on, for neck weakness, shoulder, and upper back pain. I have been violently adjusted and manipulated! During my last bout, I was going three times a week for these "adjustments" for about five weeks, with symptoms worsening. Two weeks ago, I started having right arm tingling and I told the chiropractor about it. After manipulation, he looked at the symptom sheet and asked when the tingling started. I told him that severe pain in my upper back and tingling in my arm began earlier that week. He then said I had a disc injury and that I must have done it from throwing my head around! I am a 38-year-old woman and I have not thrown my head around!

He put my head in cervical traction, which felt good for the first 30 seconds and then began to feel uncomfortable. After about five minutes of being left alone in traction, I removed it myself. He then told me that the muscles responded to the treatment and that I definitely had a cracked disc, which he could treat nonsurgically if I came in right away for treatments. I left the office in disbelief and drove directly to my general practitioner where I made an appointment for the next morning. I went home with the worst pain and iced the area for a couple of hours.

The next day, an MRI was ordered and read two days later. It showed absolutely no disk damage, but it did show a lesion in my spinal cord. After the final reading by a radiologist, it was determined that I had a syrinx starting at C6 and descending down the cord. My neurosurgeon will do a repeat MRI in one month to see if it travels to the thoracic region, where he can safely drain it.

Now, my big question. I do not have the Chiari malformation, there is no tumor present, and I have not had any severe trauma. Is it possible that the violent manipulations caused this syrinx? This chiropractor never x-rayed me or ordered any diagnostic testing. He thought he was God and knew all. Thank God I left when I did! He also claimed he could heal my hiatal hernia, my chronic knee pain, my asthma, allergies, etc.

Answer

A syrinx is a rare fluid-filled cavity within the spinal cord (syringomyelia) that is usually congenital (present at birth) but can develop as a result of trauma or a tumor. The congenital form is commonly associated with Arnold-Chiari malformation (an extension of cerebellar brain tissue into the spinal canal).

I cannot imagine cervical or thoracic spinal manipulation being violent enough to result in the formation of a syrinx in your spinal cord. Some of the symptoms you describe could possibly be the result of excessive or forceful manipulation that has irritated spinal joints; if so, they will subside with time.

Since you do not have a herniated cervical disc, a history of trauma, a tumor, or an Arnold-Chiari malformation, you should ask your neurosurgeon if the test results (fluid drainage) show any evidence of recent spinal cord injury that might have resulted from spinal manipulation.

While plain x-rays would not have revealed a spinal cord syrinx, your case provides a good example of why spinal manipulation should never be done forcefully or unnecessarily, risking disturbance of such undetected malformations as syringomyelia.

You were wise to discontinue the spinal manipulation when you noted adverse effects. Had you continued to submit to "violent" chiropractic adjustments, there is certainly a possibility that pressure on a fluid-filled, vascular-rich syrinx could increase damage to your spinal cord. Your neurosurgeon should provide the last word on this.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This page was posted on June 23, 2002.