Association between Chiropractic Spinal Manipulation & Cauda Equina Syndrome in Adults with Low Back Pain
May
Cauda equina syndrome (CES) occurs when the nerve roots that arise directly from the spinal cord at the level of the upper lumbar spine become compressed, typically by disc herniation.
Signs and symptoms of CES may include:
- bladder/bowel dysfunction,
- reduced saddle area sensation,
- sexual dysfunction,
- low back pain (LBP), and/or
- lower extremity symptoms.
CES becomes a medical emergency when neurological deficits are present, and prompt corrective surgery is necessary within 48 hours to prevent permanent damage. Fortunately, CES is a rare condition which has been shown to affect only 0.27% of LBP patients presenting to a medical specialist.
Medicolegal cases related to CES occur regularly within both the chiropractic and physical therapy (PT) professions, often because the clinician fails to recognize an evolving CES and refer the patient correctly which delays an urgently needed surgery. Nonetheless, since the signs/symptoms of CES may develop gradually, the condition might not be initially apparent to the clinician, even after a thorough history and neurological evaluation. In fact, a review of medicolegal cases showed that only 27% of CES patients initially presented with loss of bowel or bladder function.
There are also concerns about cases of CES that have been reported to occur following chiropractic spinal manipulation (CSM). Since CSM increases spinal loading, it hypothetically could worsen a pre-existing disc condition which then evolves into CES. On the other hand, since CES is so rare following CSM, it is probably not an important risk factor for developing CES.
The potential for CSM to cause CES has not been well studied, with most reports in the literature being derived from individual case reports. Since the possibility of harm has been raised in these case reports and the issue has not been well studied, the authors of this current study considered it necessary to examine the possible association between receiving CSM and the risk of subsequent CES in adults with LBP. They hypothesized that adults with LBP receiving CSM have no significant increased risk of CES compared to those undergoing PT evaluation without spinal manipulation.
RESEARCH REVIEW: Association between Chiropractic Spinal Manipulation & Cauda Equina Syndrome in Adults with Low Back Pain
This paper was published in PLoS One (2024) – open access to paper here
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