Appropriate Reporting of Acupuncture-Related Adverse Events Should be Promoted in Case Reports

Article information

Perspect Integr Med. 2025;4(1):65-66

Publication date (electronic) : 2025 February 28

doi : https://doi.org/10.56986/pim.2025.02.009

Tae-Hun Kim^1,, Jung Won Kang²

¹Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea

²Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea

^*Corresponding author: Tae-Hun Kim, Korean Medicine Clinical Trial Center, Kyung Hee University, Korean Medicine Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea, Email: rockandmineral@gmail.com

Received 2024 September 25; Revised 2024 October 21; Accepted 2024 November 06.

A case study published in November 2024 in the Annals of Neurology titled “Intramedullary Spinal Cord Abscess Caused by Acupuncture” [1] reported a 27-year-old man who had visited the hospital with bilateral upper limb muscle weakness, pain, and numbness that had started a week previously, followed by urinary retention and constipation. The medical history revealed that the patient had received acupuncture treatment for neck pain. Magnetic resonance imaging (MRI) of the cervical spine showed a diffuse longitudinal lesion from C2 to T3, with syringomyelia detected at C2 and C3. Microbiology cell culture of the intramedullary cyst contents revealed the presence of Klebsiella pneumoniae. Given this information, would the study benefit from a more appropriate title? There are many causes of syringomyelia. For the authors to conclude that acupuncture caused syringomyelia appears to be an example of post hoc ergo propter hoc (whereby a preceding event cannot be assumed to be the cause of a following event). Sufficient evidence (detailed information about acupuncture practice) was not provided in this article to support this conclusion.

Reporting that acupuncture caused an intramedullary spinal cord cyst was flawed, with no scientific rationale provided. Information regarding when and how the acupuncture treatment was performed including: (1) the duration between the acupuncture treatment and the diagnosis of the syringomyelia; (2) the acupuncture points used; (3) the depth and direction of needle insertion; (4) the length and diameter of the needles; (5) the number of treatments; (6) whether a qualified experienced practitioner performed the procedure; and (7) whether proper sterilization and hospital hygiene were maintained [2] should have been clearly described in the report.

If the authors were without detailed information on the acupuncture treatment, it seems illogical to conclude that acupuncture treatment for neck pain caused the syringomyelia. However, if the authors had this information and failed to report the circumstances of acupuncture which were purportedly causal in the development of the syringomyelia, then the authors also failed to provide a warning for practitioners of the associated risk and prevention of acupuncture-related adverse events in the future.

It is essential to examine the possibility of other causes of syringomyelia formation in the cervical spinal cord besides acupuncture. The MRI scans of this patient showed multiple lesions with edema in the cervical spinal area and syringomyelia formation at the C2 and C3 levels in the cervical spinal cord. The symptoms of the patient (bilateral upper limb weakness, pain, and numbness) seem likely to be associated with the affected cervical spinal nerves [1] which potentially might have been the reason that the patient was treated with acupuncture.

Syringomyelia is a rare condition which can either be congenital (including myelomeningocele and tethered cord syndrome) or acquired (including spinal cord injury, infection, or tumor, and meningitis), it can be present over many years without causing symptoms, and is typically diagnosed in patients between 20 and 50 years old. As the cyst grows, nerve compression and injury may occur. Assessing the patient’s pre-existing conditions and excluding other possible causes would be crucial in identifying a potential cause of the symptoms and the cyst, and any related association.

To improve the quality of case reporting, authors stating events as acupuncture related adverse events need to include the necessary information on acupuncture treatment methods, practitioner expertise, patient risk factors, and other potential causes of adverse events to support their conclusions [3]. When performed by skilled practitioners, acupuncture has a low incidence of serious adverse events. Whilst this article may have value from the perspective of neuroimaging of these rare cases, it is important to be cautious in the interpretation of the causality. This would avoid overstating the risks associated with acupuncture treatment of neck pain.