POSTTRAUMATIC MYELOPATHY FOLLOWING FLOPPING HIGH JUMP - A PILOT CASE OF SPINAL MANIPULATION

Objective: To present the first case of spinal cord injury from high j ump and the first pilot case of spinal manipulation for post-traumatic myelopathy. Clinical Features: An 11-yr-old tetraplegic boy was admit ted to the hospital, where he had a thorough neurological examination. including myelogram, EEG and skull and spinal X rays, with normal fin dings. The author revealed subtle subluxations on plain X-ray films. T riceps hyperreflexia was detected bilaterally. Bilateral patella and a nkle clonus with hyperreflexia, basic and excess spasticity, and bilat eral extensor plantar responses were noted in the lower limbs. A clini cal diagnosis of early post-traumatic incomplete spastic tetraplegia b elow C7 was made. Intervention and Outcome: He did not respond to 3 mo nths of orthodox conservative hospital management, including steroid t herapy. Spinal manipulation of the lower cervical and upper thoracic s pine was performed in a private chiropractic clinic for 2 wk. He appar ently recovered after 3 months of spinal manipulation. On recent exami nation, he has virtually completely recovered. He still suffers from h and muscle atrophy, hyperreflexia of the triceps and ankle reflex and bilateral positive Babinski reflex; ankle and patellar clonus are almo st absent. Conclusions: The early response and long-term (9-yr follow- up) benefits of spinal manipulation to the early delayed traumatic mye lopathy of this patient suggest spinal cord ischemia as its pathophysi ology. Mechanisms of post-traumatic myelopathy are postulated. Biomech anical mechanisms of spinal manipulation for neurological recovery of post-traumatic myelopathy and/or radiculopathy are advanced. Further p ilot spinal manipulation by experienced chiropractors after adequate a nti-edematous (steroid) therapy is recommended for selected patients w ith post-traumatic myelopathy and/or radiculopathy, especially in a mu ltidisciplinary spinal injury unit.