Pathological vertebral fractures after spinal manipulation.

A 52 year old airline employee presented in August 1983 with a six month history of pain in the thoracic spine, which had developed suddenly while he was mending a window. Three months after onset the pain had worsened, but radiographs requested by his general practitioner were reported as showing only degenerative changes, and the haemoglobin concentration and a full blood count were normal. The specimen tube for estimation of plasma viscosity was lost. Three weeks before presentation he had undergone three sessions ofmanipulation of the thoracic spine by a physiotherapist. After this he had noticed that the thoracic spine was unstable and he could stand upright only by levering himself upwards with his thumbs tucked into the waistband of his trousers. Examination showed a knuckle kyphos at the level of the ninth thoracic vertebra, and this area was tender. Straight leg raising was 900 on each side and there was no neurological deficit in the legs or other symptoms or signs of cord compression. Radiographs disclosed a pathological crush fracture of the ninth thoracic vertebral body with circumscribed radiolucent areas suggestive of multiple myeloma in the ribs and pelvis. Review of the previous films showed that these deposits were present at that time. Multiple myeloma was confirmed by examination of the bone marrow. Immunoelectrophoresis showed an abnormal band of IgG x protein. The pain from the fracture resolved with local radiotherapy and chemotherapy with melphalan and prednisone.