2000 Home Demonstration Garden

Doppler insonation of vertebral artery blood flow changes associated with cervical spine rotation: Implications for manual therapists

“…The accuracy and reliability of TCD is also enhanced if used with a color Doppler system (Kaps, Seidel, Bauer, and Behrmann, 1992;Bazzocchi, Quaia, Zuiani, and Moroldo, 1998). Computerized tomography angiography (CTA) (Villavicencio, Leveque, Fukushima, and Friedman, 2001;Hollingworth et al, 2003) and magnetic resonance angiography (MRA) (Weintraub and Khoury, 1995;Dumas et al, 1996;Combs and Triano, 1997;Nakagawa et al, 1998;Haynes et al, 2002;Leclerc and Pruvo, 2000;Heiserman, 2001;Sheth, Winslow, and Mikulis, 2001;Guppy et al, 2002) have also been used alone or with Doppler sonography.…”

“…The probe is manipulated in the midline, thus avoiding the cervical paravertebral muscles that may cause falsenegative recordings. Insonating the extracranial VA as it passes over the posterior arch of the atlas vertebra or between the first two cervical vertebrae, from a lateral position (Haynes, 2000;Haynes, Hart, and McGeachie, 2000), may be made more difficult by this neck muscle bulk, particularly during rotation of the cervical spine. It must be acknowledged, however, that the TCD system is very expensive and, therefore, not available to many researchers and clinicians.…”

“…It must be noted that in all Doppler systems, random errors, such as inaccurate beam-to-artery axis angle, depth and location of the particular vessel, and maintaining the measurement parameters during cervical spine rotation, may confound the results (Gill, 1985;Holland et al, 1996). Because of the potential for multiple sources of error confounding studies (Holland et al, 1996), repeated measures of blood flow are advised (Gill, 1985;Haynes, 2000).…”

“…PW-Doppler sonography is considered by many researchers to be an accurate and validated tool for blood flow velocity measurements (Taylor, Burns, and Wells, 1995;Bazzocchi, Quaia, Zuiani, and Moroldo, 1998;Paivansalo, Suramo, Merikanto, and Lindholm, 1998;Haynes, 2000Haynes, , 2002Haynes, Hart, and McGeachie, 2000;Haynes et al, 2002) that can be used to measure relative changes in blood flow volume in terms of real time (Aaslid, 1986;Harders, 1986;Schoning and Walter, 1992). PW-Doppler is particularly useful for blood flow measurements in intracranial vessels (transcranial Doppler: TCD) (Aaslid, 1986;Harders, 1986;Hoskins, 1990;Brautaset, 1992;Kaps, Seidel, Bauer, and Behrmann, 1992;Newell and Aaslid, 1992;Rossitti, Volkmann, and Stephensen, 1993;Terenzi and DeFabio, 1996), through natural ''windows'' in the skull, such as the foramen magnum.…”

“…Most of the documented measurements of VA blood flow were made at several different levels (Figure 1), such as the pretransverse (first) part of the VA (VA1: Licht, Christensen, Hojgaard, and Hoilund-Carlsen, 1998a;Licht, Christensen, Hojgaard, and Marving, 1998b;Licht, Christensen, and Hoilund-Carlisen, 1999; the cervical vertebral level (second part) (VA2: Refshauge, 1994;Thiel, Wallace, Donat, and Yong-Hing, 1994;Haynes, 1996Haynes, , 2000Rivett, Milburn, and Chapple, 1998;Haynes, Hart, and McGeachie, 2000;Haynes and , 2001;Zaina et al, 2003;Arnold, Bourassa, Langer, and Stoneham, 2004), and in the region of the axis (VA2: Stevens, 1991;Refshauge, 1994;Haynes, 1996Haynes, , 2000Rivett, Milburn, and Chapple, 1998;Haynes, Hart, andMcGeachie, 2000, Haynes andMilne, 2001). No studies of the suboccipital (third) part of the VA (VA3) are reported in the current literature.…”