A Signal for Caution: Eight Cases of Neurological Injury after Spinal Manipulation and Implications for Future Surveillance

Abstract

Aims: We present a two-year, single-center retrospective case series on spine-related complications caused by unregulated spinal manipulation. Study Design: This is a retrospective case series. Place and Duration of Study: A tertiary hospital from 1 January 2024 to 31 December 2025 (24 months). This study included adults aged 18–65 who presented with spine-related injuries secondary to spinal manipulation. Methodology: A search was conducted in the hospital records. Patients’ data were tabulated and analyzed using descriptive statistics for variables including demographics, diagnosis, American Spinal Injury Association (ASIA) Impairment Scale, and treatment outcomes. Results: Eight patients (seven male, one female), aged 18 to 57 years (mean = 39.1), were included. There were six cervical injuries and two thoracic injuries, including one case of cervical metastasis and one of thoracic ossification of the ligamentum flavum (yellow ligament). Four cervical patients had pre-existing cervical spondylosis. One cervical and one thoracic patient had no predisposition. In the cervical region, five patients suffered ASIA C and D injuries, while one patient suffered an ASIA A injury from massaging and abdominal bracing. In the thoracic region, one patient suffered an ASIA A injury from a practitioner standing on the thoracic spine, and another suffered an ASIA D injury from spinal rotation. Two cervical patients underwent operative treatment and showed improvement, while those receiving conservative treatment showed no worsening. The ASIA A patients succumbed to subacute complications of their injuries. Conclusion: Accurate diagnosis and the exclusion of serious pathology are mandatory prerequisites to any treatment. Aggressive maneuvers should be avoided, while ensuring judicious and controlled application of force, with heightened caution in the cervical region, particularly when untrained manipulation is involved. Prognostically, the initial severity of the injury remains the most critical factor; however, in cases of incomplete neurological deficits, timely surgical decompression may significantly improve functional outcomes.