- 期刊
Cervical Disc Herniation with Myelopathy Following Cervical Tuina Manipulation
頸椎徒手推拿後併發頸椎椎間盤突出及脊髓病變
摘要
Complications following cervical manipulation can be classified as cerebrovascular or noncerebrovascular complications. The former complications occur more frequently, and they are usually due to vertebral artery occlusion, damage or thrombus formation. The latter include spinal cord or nerve root injuries and have seldom been reported. Herniation of the cervical disc with myelopathy following manipulation is rare. However, we have encountered two patients who developed cervical disc herniation with myelopathy secondary to cervical tuina manipulation for nuchalgia at the bone setting facilities. One of the patients suffered from shooting pain during manipulation and developed tetraparesis two days later. An MRI examination revealed herniation of the intervertebral disc at the C4-5 level. Another patient suffered from right hemiplegia immediately after manipulation and was initially diagnosed with a cerebrovascular accident. Tetraplegia developed a few days later and an MRI study demonstrated herniation of the intervertebral disc at the C3-4 and C4-5 levels with prominent cord compression. Both patients underwent cervical discectomy with bone fusion and received rehabilitation therapy after the operation. They satisfactorily improved and could ambulate with a nearly normal gait without requiring an assistive device. The risk of cervical disc herniation with myelopathy following cervical manipulation cannot be overemphasized because an early diagnosis and timely intervention are vital. While skillful techniques and appropriate force need to be applied to the neck during manipulation, the same care must be taken to reduce the risk of complications following manipulation.
並列摘要
頸椎徒手治療所導致的併發症可分為腦血管及非腦血管兩類併發症，前者較常發生，主要原因為椎動脈阻塞、血管壁損傷或血栓所致。後者的併發症包括脊髓或神經根損傷，較少文獻曾報導此類併發症。脊椎徒手治療後併發頸椎間盤突出及頸脊髓損傷極少發生，本文報導兩例此類案例。第一位案例於徒手推拿過程中突感由頸部向下延伸之刺痛，隔兩天發生四肢輕癱之症狀，核磁共振掃描顯示頸椎第四與第五節椎間盤突出。第二位案例於徒手推拿後馬上發生右側肢體偏癱，最初被診斷為腦血管中風，但數天後病情進展到四肢輕癱，核磁共振掃描顯示頸椎第三與第四節和第四與第五節椎間盤突出合併脊髓壓迫。兩位患者都接受頸椎間盤切除與骨融合手術，並且於術後進行復健治療，其運動功能皆恢復至不須輔具可獨立行走，步態也接近正常。雖然脊椎徒手治療後發生頸椎椎間盤突出合併脊髓壓迫的文獻報導不多，但仍應重視其發生之可能性，因為早期的診斷和及時的介入對於預後相當重要。實行脊椎徒手治療除了需注意技術的正確熟練與力道之外，建議於整個治療過程及治療後仍需注意病人的症狀變化，給予適時的評估與治療以降低併發症。