Abstract
Objective
The objective of the study was to investigate the cerebrovascular hemodynamic response
of cervical spine positions including rotation and cervical spine manipulation in
vivo using magnetic resonance imaging technology on the vertebral artery (VA).
Methods
This pilot study was conducted as a blinded examiner cohort with 4 randomized clinical
tasks. Ten healthy male participants aged 24 to 30 years (mean, 26.8 years) volunteered
to participate in the study. None of the participants had a history of disabling neck,
arm, or headache pain within the last 6 months. They did not have any current or history
of neurologic symptoms. In a neutral head position, physiologic measures of VA blood
flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic
resonance imaging after 3 different head positions and a chiropractic upper cervical
spinal manipulation. A total of 30 flow-encoded phase-contrast images were collected
over the cardiac cycle, in each of the 4 conditions, and were used to provide a blood
flow profile for one complete cardiac cycle. Differences between flow (in milliliters
per second) and velocity (in centimeters per second) variables were evaluated using
repeated-measures analysis of variance.
Results
The side-to-side difference between ipsilateral and contralateral VA velocities was
not significant for either velocities (P = .14) or flows (P = .19) throughout the conditions. There were no other interactions or trends toward
a difference for any of the other blood flow or velocity variables.
Conclusions
There were no significant changes in blood flow or velocity in the vertebral arteries
of healthy young male adults after various head positions and cervical spine manipulations.
Key Indexing Terms
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References
Public Health Agency of Canada. Tracking Heart Disease & Stroke in Canada [Internet]. Ottawa: Public Health Agency of Canada; 92p. [cited 2011 April 25]. Ottawa; 2009 p. 1–118. Available from: www.phac-aspc.gc.ca/publicat/2009/cvd-avc/pdf/cvd-avs-2009-eng.pdf
- Neurosonographic monitoring of 105 spontaneous cervical artery dissections: a prospective study.Neurology. 2010; 75: 1864-1870
- Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings.Neurology. 2001; 57: 827-832
- Cervical-artery dissections: predisposing factors, diagnosis, and outcome.Lancet Neurol. 2009; 8: 668-678
- An etiologic model to help explain the pathogenesis of cervical artery dissection: implications for cervical manipulation.J Manipulative Physiol Ther. 2006; 29: 336-338
- An analysis of the etiology of cervical artery dissections: 1994 to 2003.J Manipulative Physiol Ther. 2005; 28: 617-622
- Ultrasound findings in spontaneous extracranial vertebral artery dissection.Stroke. 1993; 24: 1910-1921
- Neurosonographical follow-up in patients with spontaneous cervical artery dissection.Neurol Res. 2008; 30: 687-689
- Critical neck position as an independent risk factor for posterior circulation.J Neuroimaging. 1995; 5: 16-22
- Vertebral arteries and neck rotation: Doppler velocimeter and duplex results compared.Ultrasound Med Biol. 2000; 26: 57-62
- Doppler studies comparing the effects of cervical rotation and lateral flexion on vertebral artery blood flow.J Manipulative Physiol Ther. 1996; 119: 378-384
- Effect of various head and neck positions on vertebral artery blood flow.Clin Biomech. 1994; 9: 105-110
- Changes in vertebral artery blood flow following normal rotation of the cervical spine.J Manipulative Physiol Ther. 2003; 26: 347-351
- Is cervical spine rotation, as used in the standard vertebrobasilar insufficiency test, associated with a measureable change in intracranial vertebral artery blood flow?.Man Ther. 2004; 9 (Available from:): 220-227
- Real-time ultrasound measurements of changes in suboccipital vertebral artery diameter and blood flow velocity associated with cervical spine rotation.Physiother Res Int. 2008; 13: 241-254
- The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation.J Neurol. 2008; 255: 371-377
- Vertebral artery blood flow velocity changes associated with cervical spine rotation: a meta-analysis of the evidence with implications for professional practice.J Man Manip Ther. 2009; 17: 46-57
Licht P, Christensen H, Højgaard P, Marving J. Vertebral artery flow and spinal manipulation: a randomized, controlled and observer-blinded study. J Manipulative Physiol Ther 1998;21:141–4. A.
- Effectiveness of manual therapies: the UK evidence report.Chiropr Osteopath. 2010; 18: 3
- Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.Spine. 2004; 4: 335-356
- Risk of vertebrobasilar stroke and chiropractic care: results of a population based case control and case-crossover study.Spine. 2008; 33: 176-183
- Manipulation or mobilisation for neck pain: a Cochrane review.Man Ther. 2010; 15: 315-333
- Epidemiology: spinal manipulation utilization.J Electromyogr Kinesiol. 2012; 22: 648-654
- Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.J Manipulative Physiol Ther. 2009; 32: S141-S175
- A randomized trial of chiropractic manipulation and mobilization for patients with neck pain: clinical outcomes from the UCLA neck-pain study.Am J Public Health. 2002; 92: 1634-1641
- Examining vertebrobasilar artery stroke in two Canadian provinces.J Manipulative Physiol Ther. 2008; 32: 194-200
- Vertebral artery flow and cervical manipulation: an experimental study.J Manipulative Physiol Ther. 1999; 22: 431-435
- Vertebral artery volume flow in human beings.J Manipulative Physiol Ther. 1999; 22: 363-367
- Negative ultrasound findings in patients with cervical artery dissection.Negative ultrasound in CAD. J Neurol. 2006; 253: 424-433
- Ultrasound in spontaneous cervical artery dissection.Perspectives in Medicine. 2012; 1: 250-254
- Color duplex sonographic findings in human vertebral arteries during cervical rotation.J Clin Ultrasound. 2001; 29: 14-24
- Peripheral arterial disease: gadolonium-enhanced MR angiography versus color-guided duplex US—a meta-analysis.Radiology. 2000; 216: 67-77
- Quantitative 2D and 3D phase contrast MRI: optimized analysis of blood flow and vessel wall parameters.Magn Reson Med. 2008; 60: 1218-1231
- Evaluation of the vertebral arteries with duplex sonography.J Vasc Surg. 1986; 3: 523-530
- Blood-flow volume quantification in internal carotid and vertebral arteries: comparison of 3 different ultrasound techniques with phase-contrast MR imaging.Am J Neuroradiol. 2006; 27: 363-369
- Normal vertebral artery hemodynamics and pathology. Vascular ultrasound of the neck. Lippincott Williams & Wilkins, Philadelphia2001: 107-119
- Cervical cerebral artery dissection: a multicenter prospective study (preliminary report).Neurol Sci. 2003; : 4-7
- Sensitivity of neurovascular ultrasound for the detection of spontaneous cervical artery dissection.J Clin Neurosci. 2009; 16: 79-82
- Spontaneous dissection of the carotid and vertebral arteries.N Engl J Med. 2001; 344: 898-906
- Blood flow volume quantification of cerebral ischemia: comparison of three noninvasive imaging techniques of carotid and vertebral arteries.Imaging. 2002; : 551-556
- Muscle function and resting energy expenditure in female athletes with cystic fibrosis.Am J Respir Crit Care Med. 2003; 168: 1476-1480
- Motions of the head and thorax during neck manipulations.J Manipulative Physiol Ther. 1994; 17: 573-583
- Biomechanical performance of spinal manipulation therapy by newly trained vs. practicing providers: does experience transfer to unfamiliar procedures?.J Manipulative Physiol Ther. 1995; 18: 347-352
- Developing skilled performance of lumbar spine manipulation.J Manipulative Physiol Ther. 2002; 25: 353-361
- Quantitative feedback versus standard training for cervical and thoracic manipulation.J Manipulative Physiol Ther. 2003; 26: 131-138
- Measurement with imaging: basic facts and implementation 1.Radiographics. 2002; 22: 651-671
- Design and validation of segment—freely available software for cardiovascular image analysis.BMC Med Imaging. 2010; : 1-13
- Analysis of noise in phase contrast imaging.Med Phys. 1996; 23: 857-869
- Applications of phase-contrast velocimetry sequences in cardiovascular imaging.Diagn Interv Imaging. 2012; 93: 159-170
- Learning spinal manipulation skills: assessment of biomechanical parameters in a 5-year longitudinal study.J Manipulative Physiol Ther. 2010; 33: 226-230
- Maturation in rate of high-velocity, low-amplitude force development.J Manipulative Physiol Ther. 2011; 34: 173-180
- Hemodynamics.in: Taylor K Burns P Wells P Clinical applications of Doppler ultrasound. 2nd ed. Raven Press, New York, NY1995: 35-53
- Best duplex-sonographic criteria for the assessment of renal artery stenosis—correlation with intra-arterial pressure gradient.Ultraschall Med. 2007; 28: 45-51
- Doppler criteria for identifying proximal vertebral artery stenosis of 50% of more.J Ultrasound Med. 2011; 30: 163-168
- Reference values for vertebral artery flow volume by duplex sonography in young and elderly adults.Stroke. 1999; 30: 2692-2696
- Is mechanical deformation of the suboccipital vertebral artery during cervical spine rotation responsible for vertebrobasilar insufficiency?.Physiother Res Int. 2008; 13: 53-66
- Internal forces sustained by the vertebral artery during spinal manipulative therapy.J Manipulative Physiol Ther. 2002; 25: 504-510
- Preliminary report: biomechanics of vertebral artery segments C1-C6 during cervical spinal manipulation.J Manipulative Physiol Ther. 2010; 33: 273-278
- Microstructural damage in arterial tissue exposed to repeated tensile strains.J Manipulative Physiol Ther. 2010; 33: 14-19
Article info
Publication history
Published online: November 18, 2013
Accepted:
July 31,
2013
Received in revised form:
July 12,
2013
Received:
May 7,
2013
Identification
Copyright
© 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
