J Yeungnam Med Sci.  2023 Nov;40(Suppl):S109-S112. 10.12701/jyms.2023.00479.

Shunt fracture as a sequela of cervical spine manipulation: a case report

• Kim E

• KMID: 2548351
• DOI: http://doi.org/10.12701/jyms.2023.00479

Abstract

Shunt disconnection is an unreported complication of spinal mobilization and manipulation. We present the case of a young adult who underwent cystoperitoneal (CP) shunt placement for an arachnoid cyst at the age of 6 years. The shunt remained functional during a follow-up period of 11 years. The patient was admitted with headache and diplopia that started after cervical manipulation by a chiropractor. Radiography revealed fracture of the distal catheter and resultant enlargement of the temporosylvian cyst. The patient required replacement of the disconnected tubing caudal to the shunt valve. The distal catheter ruptured immediately below the outlet connector of the valve. The symptoms and signs resolved completely after insertion of a new distal tube into the peritoneum. This case report demonstrates that chiropractic manipulation of the neck may be a cause of tubing breakage in patients with CP shunts.

Keyword

Arachnoid cysts; Chiropractic; Cystoperitoneal shunt; Shunt disconnection; Shunt fracture

Figure

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  Fig. 1. Fracture of cystoperitoneal (CP) shunt following cervical chiropractic therapy. (A) An enhanced coronal computed tomography (CT) image shows a large arachnoid cyst with remarkable mass effect. (B) Head CT taken 2 years after the CP shunt reveals disappearance of the Sylvian cyst. (C) Admission CT scan depicts a regrowing cyst and its mass effect on the cerebral cortex. (D) Neck X-ray discloses breakage of the shunt tubing at its cervical portion (arrow). (E) There is complete resolution of the cyst recurrence following the revision shunt surgery.

Reference

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