Changes in Cerebellar Blood Flow After Manipulation of the Cervical Spine Using Technetium 99m–Ethyl Cysteinate Dimer

Cagnie, Barbara; Jacobs, Filip; Barbaix, Erik; Vinck, Elke; Dierckx, Rudi; Cambier, Dirk

doi:10.1016/j.jmpt.2005.01.005

« Previous Next »Journal of Manipulative and Physiological Therapeutics
Volume 28, Issue 2 , Pages 103-107, February 2005

Changes in Cerebellar Blood Flow After Manipulation of the Cervical Spine Using Technetium 99m–Ethyl Cysteinate Dimer

Barbara Cagnie, PT
- Doctoral student, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Submit requests for reprints to: Barbara Cagnie, PT, Department of Rehabilitation Sciences and Physiotherapy, Ghent University Hospital, De Pintelaan 185, 6K3, B-9000 Ghent, Belgium.
Filip Jacobs, MSc, PhD
- Medical Physicist, Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
Erik Barbaix, MD
- Research Assistant, Department of Human Anatomy, Embryology, Histology and Medical Physics, Ghent University, Ghent, Belgium
Elke Vinck, PT
- Doctoral student, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
Rudi Dierckx, MD, PhD
- Professor, Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
Dirk Cambier, PT, PhD
- Professor, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium

Background

Cervical spine manipulation is one of the many interventions practiced by health professionals to treat musculoskeletal disorders of the cervical spine. Although serious consequences of manipulation have been documented, the incidence is thought to be rare. More frequently, there may be minor transient side effects after manipulation of the cervical spine, such as headache, dizziness, and nausea. One of the hypothesis is that these side effects are caused by ischemia in the areas perfused by the vertebral arteries.

Objective

The purpose of this study was to investigate whether manipulation of the cervical spine can influence blood flow in the brain.

Methods

Single photon emission computed tomography was used to examine changes in regional cerebral blood flow caused by cervical spine manipulation (CSM) performed by a physiotherapist to 15 volunteers, using a 1-day split-dose Technetium 99m–ethyl cysteinate dimer single photon emission computed tomography activation paradigm.

Results

One brain region was identified showing a decreased regional cerebral blood flow after manipulation. This region was situated in the anterior lobe of the left cerebellum (−42, −48, −24).

Conclusions

These findings suggest that cerebellar hypoperfusion may occur after CSM. This could explain why certain people experience headache, dizziness, or nausea after CSM. Further investigation into patient symptoms in the presence of cerebellar hypoperfusion and the possible link of these findings with other adverse reactions are warranted.