Internal Decapitation: A Possible Rare Complication of Chiropractic Treatment?

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Since working from home has become more common, we have seen an increase in back and neck problems. Working at a makeshift desk or the dining room table is rarely suitable for proper spinal alignment. This can result in a sore, stiff back that makes sleeping and other daily activities difficult.

Chiropractic care is a popular treatment for these aches and pains. For the most part, this care is safe and effective. But performed improperly, it can have serious health consequences.


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A recent malpractice lawsuit alleged that one of these potential complications includes a rare orthopedic injury known as an internal decapitation.

What is Internal Decapitation?

Internal decapitation is an extremely rare injury (less than 1% of all cervical injuries) that occurs when the ligaments that hold the spinal column and the base of the skull together become disrupted. The condition is also known as:

  • Occipitocervical dissociation
  • Atlanto-occipital dislocation
  • Orthopedic decapitation

The most common cause of internal decapitation is a high-speed motor vehicle accident or being a pedestrian struck by a motor vehicle. Although any situation that involves sudden deceleration and severe whiplash-like motion can cause it.


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Internal decapitation is immediately fatal in about 70% of cases. Another 15% of patients who survive the initial injury will pass away during the subsequent hospital stay. Due to the considerable force required to cause most instances of internal decapitation, patients often have multiple additional traumatic injuries that can affect their survival.

For patients who do initially survive, treatment includes stabilizing the spine with a cervical collar and then performing surgery to fix the cervical spine and skull base back together with hardware.

Can Chiropractic Treatment Cause Internal Decapitation?

A chiropractic adjustment or spinal manipulation is a procedure where a trained specialist uses their hands or a small instrument to apply a sudden but controlled force to a spinal joint. It typically produces a popping sound. The goal of this procedure is to improve spinal motion and improve the body’s function.

Spinal manipulation is most commonly performed by a chiropractor but can occasionally be used by osteopaths, physiotherapists, or other physicians. It is used to treat low back pain, neck pain, and headaches.


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Despite its widespread use, chiropractic adjustment is somewhat controversial. Critics typically cite contradictory evidence from randomized controlled trials that show benefits.

Serious complications can occur if spinal manipulation is done incorrectly. If a provider is too aggressive, uses an improper technique, or misses contraindications to spinal manipulation, high-velocity thrusts can result in catastrophic injuries.

While the medical literature doesn’t document a case of internal decapitation that was definitively caused by chiropractic manipulation, anecdotal claims can be found. The procedure also can lead to other adverse events.

Other Potential Side Effects

While internal decapitation may or may not be a complication from spinal manipulation, there are several other recognized adverse events that can happen.

High-velocity chiropractic maneuvers have been associated with damage to the cervical and vertebral arteries in the neck. While also rare, this can lead to the patient experiencing a stroke, which can have a wide range of health consequences.

Other known adverse events that can be caused by professional or at-home spine manipulation include:

  • Nerve injury
  • Headache
  • Stiffness
  • Swelling
  • Disc herniation
  • Bruising
  • Fracture

In most of these cases, symptoms were minor. Even in those with more severe injuries, most patients made a full recovery.

Long-Term Consequences

For those that experience internal decapitation and survive, no matter what the injury that caused it, the road to recovery is slow and long.

There are isolated cases of patients who recover from surgical repair and regain the ability to walk. However, many patients experience long-term health consequences such as: inability to move the arms and legs, loss of feeling below the neck, vascular complications, fluid build-up in the brain, brain damage and trouble breathing.

Patients will require extensive medical care and rehabilitation. Most will require costly life-long care.


Mary Smallwood

Mary Smallwood is a USAF veteran, Registered Nurse, and Legal Nurse Consultant. She operates Smallwood Legal Nurse Consulting in North Florida where she uses her 25 years of nursing experience across multiple specialties to provide the legal community with expert medical record review, analysis, education, and reporting. She enjoys spending time with her family, running a small animal rescue, and serving as President of the Orlando chapter of the American Association of Legal Nurse Consultants.

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