Case Report/Case SeriesBilateral Diaphragmatic Paralysis Due to Cervical Chiropractic ManipulationJohn, Seby MD; Tavee, Jinny MDAuthor Information Department of Neurology, Cleveland Clinic, Cleveland, OH The authors declare no conflict of interest. Reprints: Jinny Tavee, MD, Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, S90, Cleveland, OH 44195. E-mail: firstname.lastname@example.org. The Neurologist: February 2015 - Volume 19 - Issue 3 - p 65-67 doi: 10.1097/NRL.0000000000000008 Buy Metrics Abstract Neck pain from cervical spinal disease is a common problem with significant disability, and chiropractic manipulation has emerged as one of the leading forms of alternative treatment for such spinal symptoms. However, more experience with these forms of treatment has revealed associated complications that are far from benign. Complications range from mild symptoms, such as local neck tenderness or stiffness, to more severe injuries involving the spinal cord, peripheral nerve roots, and arteries within the neck. Phrenic nerve injury causing diaphragmatic palsy is a rare complication of cervical chiropractic manipulation. We report a case of bilateral diaphragmatic paralysis in a healthy gentleman who underwent cervical manipulation. Physicians must be aware of this complication and should be cautious when recommending spinal manipulation for the treatment of neck pain, especially in the presence of preexisting degenerative disease of the cervical spine. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.