Cervical myelopathy after neck manipulation in a patient with cervical spondylosis with radiculopathy. Cause and effect or natural progression?

Introduction Cases have been reported in which myelopathy has occurred secondary to neck manipulation. We present a case report of a 47-year-old female, with cervical spondylosis with radiculopathy, who presented with clinical signs and radiological evidence of cervical myelopathy during her followup visit, after a failure of outpatient physical therapy. Symptoms subsided after emergent decompression surgery. It is critical to recognize cervical myelopathy and institute timely intervention. The conservative management modalities should be practiced keeping in mind the potential of cervical spondylosis to progress to catastrophic complications such as myelopathy. It may be difficult to accurately implicate neck manipulation in the onset of the cervical myelopathy as it may be clinically silent or coexist with radiculopathy before becoming clinically evident It is of paramount importance to adequately counsel, reassure, and explain the patient, about this phenomenon as this, can place the physician at legal risk. Results/Case report We present a case report of a 47-year-old female, with cervical spondylosis with radiculopathy, who presented with clinical signs and radiological evidence of cervical myelopathy during her follow-up visit, after the failure of outpatient physical therapy. Symptoms subsided after emergent decompression surgery. Discussion It is important for physicians to be aware of the possibility of a chronic pain patient with cervical spondylosis with or without radiculopathy progressing to acute cervical myelopathy. There are case reports of patients developing complications before or after neck manipulation. All the authors have unanimously echoed that disk herniation can progress on its own to myelopathy without provocation and the cause- effect relationship between the manipulation and the radiculopathy or cervical myelopathy is ambiguous at its best. It is critical to recognize the signs and symptoms of cervical myelopathy and institute timely intervention. The conservative management modalities such as neck manipulation should be practiced keeping in mind the potential of pathology to progress to catastrophic complication such as myelopathy. There is a consensus that the causal relationship between manipulation and the subsequent appearance of symptoms should not be assumed as the progression a may simply be a result of the natural history of the disease. It is of paramount importance to adequately counsel, reassure, and explain the patient, about this phenomenon as this can place the physician at legal risk