Cervical Spine Manipulation: An Alternative Medical Procedure with Potentially Fatal Complications

Leon-Sanchez, Andres; Cuetter, Albert C.; Ferrer, Gustavo

doi:10.1097/smj.0b013e31802ed21f

Cited by 31 publications

(21 citation statements)

References 20 publications

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“…152 Similarly, stretching of the VA narrows the vascular lumen, thereby possibly promoting the development of intra-arterial thrombus. 153 Typical movements for cervical manipulation can be rotation, lateral flexion, flexion, extension, or a combination of them. [73][74][75][76] The presence of high cervical osteophytic disease or other anatomic variations may predispose to or increase the likelihood of VA injury during extension and rotation of the head.…”

Section: Postulated Mechanisms Of Vessel Injurymentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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Section: Postulated Mechanisms Of Vessel Injurymentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

View full text Add to dashboard Cite

show abstract

“…There are different osteopathic techniques, among them the Cervical Rhythmic Articulatory Technique (CRAT) 3,7,8,12 . It is described that VA dissection associated to cervical manipulation is uncommon, but it can be severe or fatal in some cases [17][18][19] . There are reports that cervical manipulation and mobilization do not pose risk to VA and carotids 13,[20][21][22] , and it is considered that vertebral and carotid arteries dissection or injury should be attributed to mechanical impact common during car accidents (whiplash) or to arterial diseases, being uncommon for cervical manipulation to generate such injury 13,19,21,23 .…”

Section: Introductionmentioning

confidence: 99%

Influence of osteopathic manipulation on blood flow velocity of the cerebral circulation in chronic mechanical neck pain

et al. 2014

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BACKGROUND AND OBJECTIVES:Osteopathic manipulation is indicated for pain, myofascial tensions and/or decreased movement amplitude. This study aimed at checking whether osteopathic manipulation with cervical rhythmic articulatory technique generates abnormal blood flow velocity oscillations or risks to internal carotid, vertebral and basilar arteries circulation. METHODS:The sample was made up of 58 individuals with chronic mechanical cervical pain (40 females and 18 males), with mean age of 36 years, submitted to internal carotid, vertebral and basilar arteries ultrasound before and after a single osteopathic manipulation with cervical rhythmic articulatory technique. Individuals were evaluated by ultrasound in three moments: control evaluation, rest control evaluation and study evaluation. Separation was sequential and methods were randomly and blindly applied. RESULTS: Ultrasound has shown no significant differences in the comparison of flow velocity variables means among evaluations. However, a slight increase in vertebral, intracranial and basilar arteries blood flow was observed after osteopathic manipulation with cervical rhythmic articulatory technique in the study evaluation, without statistical significance. CONCLUSION: In this studied population, osteopathic manipulation with cervical rhythmic articulatory technique has not generated significant blood flow velocity oscillation of internal carotid, vertebral and basilar arteries and has not posed risk to brain circulation. Keywords: Carotid arteries, Cervical pain, Doppler Ultrasound, Spine manipulation, Vertebral artery. Influence of osteopathic manipulation on blood flow velocity of the cerebral circulation in chronic mechanical neck pain*

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“…Spinal manipulation refers to a passive movement thrust of high velocity and low amplitude, usually applied at the end range of movement and is beyond the patient's control . Manipulation of the cervical spine is an aggressive procedure, which carries various risks and is often associated with worsening of symptoms 5 6. Manipulation was not considered in the treatment options for this patient because of the risks associated with it, and also because of patient's anxiety and lack of MRI-confirmed diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Safe physiotherapy interventions in large cervical disc herniations: Figure 1

Keramat

Gaughran

2012

BMJ Case Reports

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SummaryA 34-year-old woman was seen in a physiotherapy department with signs and symptoms of cervical radiculopathy. Loss of cervical lordosis and a large paracentral to intraforaminal disc prolapse (8 mm) at C5-C6 level was reported on MRI. She was taking diclofenac sodium, tramadol HCl, diazepam and pregabalin for the preceding 2 months and no significant improvement, except temporary relief, was reported. She was referred to physiotherapy while awaiting a surgical opinion from a neurosurgeon. In physiotherapy she was treated with mobilisation of the upper thoracic spine from C7 to T6 level. A cervical extension exercise was performed with prior voluntary extension of the thoracic spine and elevated shoulders. She was advised to continue the same at home. General posture advice was given. Signs and symptoms resolved within the following four sessions of treatment over 3 weeks. Surgical intervention was subsequently deemed unnecessary. BACKGROUND

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Cervical Spine Manipulation: An Alternative Medical Procedure with Potentially Fatal Complications

Cited by 31 publications

References 20 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Influence of osteopathic manipulation on blood flow velocity of the cerebral circulation in chronic mechanical neck pain

Safe physiotherapy interventions in large cervical disc herniations: Figure 1

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