Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis

Abstract

CONTEXT: Loss of cervical lordosis is associated with decreased vertebral artery hemodynamics. AIM: The aim of this study is to evaluate cerebral blood flow changes on brain magnetic resonance angiogram (MRA) in patients with loss of cervical lordosis before and following correction of cervical lordosis. SETTINGS AND DESIGN: This study is a retrospective consecutive case series of patients in a private practice. MATERIALS AND METHODS: Cervical lordosis of seven patients (five females and two males, 28–58 years) was measured on lateral cervical radiographs ranging from −13.1° to 19.0° (ideal is −42.0°). Brain MRAs were analyzed for pixel intensities representing blood flow. Pixel intensity of the cerebral vasculature was quantified, and percentage change was determined. STATISTICAL ANALYSIS USED: A Student's t-test established significance of the percentage change in cerebral blood flow between pre- and postcervical lordosis adjustment images. Regression analysis was performed. An a priori analysis determined correlation between cervical lordosis and change in MRA pixel intensity. The statistician was blinded to the cervical lordosis. RESULTS: Pixel intensity increased 23.0%–225.9%, and a Student's t -test determined that the increase was significant ( P < 0.001). Regression analysis of the change in pixel intensity versus the cervical lordosis showed that as the deviation from a normal cervical lordosis increases, percentage change in pixel intensity on MRA decreases. CONCLUSION: These results indicate that correction of cervical lordosis may be associated with an immediate increase in cerebral blood flow. Further studies are needed to confirm these findings and understand clinical implications.

Does Forward Head Posture Influence Somatosensory Evoked Potentials and Somatosensory Processing in Asymptomatic Young Adults?

“…Furthermore, since abnormal sagittal plane postures cause an increase in stress and strain on both neural and vascular tissues in the cervical spine [46,47], and it is known that neuronal tissues are highly oxygen-energy dependent [53], it is probable that increased neural strain coupled with reductions in respiratory efficiency may be a mechanism subtly impacting oxygenation to the spinal cord, nerve roots, and cerebral areas, leading to the alteration in the sensorimotor integration disturbances identified in our study. Supporting these assertions, there is evidence of an alteration in vertebral artery hemodynamics and cerebral blood flow intensity on MRA due to alterations in sagittal cervical alignment [54,55].…”

Effects of Cervical Mobilization on Balance and Gait Parameters in Individuals With Stroke: A Randomized Controlled Trial

“…Consequently, these patients may experience impaired postural perception and balance, potentially leading to negative impacts on their gait (Kim & Oh, 2014; Schinkel-Ivy et al, 2016; Tyson et al, 2006). Additionally, FHP may decrease blood flow to the brain and negatively affect neuroplastic processes, potentially impairing the development of balance and gait (Katz et al, 2019). Muscle and joint dysfunction associated with FHP may improve with mobilization (suboccipital myofacial release and joint mobilization).…”

“…In addition, these techniques may increase the activity of motor neurons that activate proprioceptive receptors, positively affecting balance (Gyer et al, 2019; Hengeveld & Banks, 2013). Cervical mobilization (CM) may improve balance and gait posture (GP) by reducing muscle spasms, correcting dysfunctions in cervical joints, and accelerating blood flow to the brain (Gyer et al, 2019; Katz et al, 2019) Although some investigators have reported positive effects of CM on balance in healthy individuals and in patients with orthopedic problems, there has been limited research examining CM effects on balance and GP in stroke survivors (T. Choi et al, 2019; T.S. Choi et al, 2020; Maden et al, 2022), leading us to undertake this investigation.…”

Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: a randomized, placebo-controlled trial

“…There is evidence to suggest that abnormal sagittal cervical alignment may place a constant, increased strain on neural and vascular elements in the cervical spine, directly impairing the blood flow to the spinal cord, nerve roots and cerebral areas 58 – 60 . For example, Katz et al 61 identified a linear correlation between cervical lordotic curve magnitude induced on the cervical denneroll orthtoic and increased MRI-angiogram cerebral blood flow pixel intensity.…”