Defining the Effect of Cervical Manipulation on Vertebral Artery Integrity: Establishment of an Animal Model

Kawchuk, Gregory N.; Wynd, Shari; Anderson, Todd A.

doi:10.1016/j.jmpt.2004.10.005

Cited by 8 publications

(8 citation statements)

References 47 publications

(48 reference statements)

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“…123 Researchers have analyzed biomechanics of the cervical spine during spinal manipulation to determine whether manipulation may cause CD. [124][125][126][127][128][129][130][131] The cervical spine is made up of 7 vertebral bodies and is divided into 4 anatomic sections: the atlas, the axis, the root (C2-C3 junction), and the column (C3-C7). 132 Movements of the cervical spine, including flexion, extension, rotation, and lateral flexion, are dependent on the orientation of the joint facets and are further restricted by muscles and ligaments surrounding the cervical vertebrae.…”

Section: Cervical Spine Biomechanics and Cmtmentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

175

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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: Cervical Spine Biomechanics and Cmtmentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

175

View full text Add to dashboard Cite

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“…As a result of the vertebral artery’s unique anatomical configuration [5], movements of the neck caused by cSMT are thought to create forces that may compromise the integrity of the neck’s vasculature [6]. As the majority of neck movements, including those caused by cSMT, occur without incident, some investigators have suggested that mechanical stimuli alone may be insufficient to create CAD de novoin healthy arteries [7] – the vessel must first be susceptible to mechanical injury [8]. A pre-existing compromise of the vertebral artery wall might therefore act as a potential susceptibility factor [9].…”

Section: Introductionmentioning

confidence: 99%

“…Towards this, Kawchuk et al[ 7] have adapted intravascular ultrasound (IVUS), a technique used to visualize human coronary vessels, to image the vertebral arteries of dogs. In their study, arterial wall lesions were generated by angioplasty and the injury dimensions were quantified using IVUS imaging [7].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Cervical Spine Manipulation on a Pre-Existing Vascular Lesion within the Canine Vertebral Artery

Wynd¹,

Anderson²,

Kawchuk³

2008

Cerebrovasc Dis

Self Cite

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Background: Serious adverse events such as cervical artery dissection (CAD) have been reported to occur following cervical spine manipulation therapy (cSMT). To investigate the relation between these events, we utilized an animal model to determine if vertebral arteries with a suspected susceptibility factor (wall lesion) could be injured further by cSMT. Methods: Lesions to the vertebral artery wall were created by angioplasty in 10 anesthetized canines. Resulting injury dimensions were quantified using intravascular ultrasound before and after cSMT. Student’s t were performed to assess the significance of changes in arterial dimension. Results: Statistical analysis demonstrated that the pre-cSMT and post-cSMT lesions did not differ significantly in their length, area or volume (p > 0.05). Conclusions: In this animal model, cSMT did not alter the dimensions of pre-existing vertebral artery lesions.

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“…Recent reports suggest an explanation for this inequity is the existence of subpopulations who may be predisposed to mechanical compromise [19] through anatomic [4,34], metabolic [30], or physiological anomalies [24,44]. It is also possible that cSMT may be provided to persons with dissections-in-progress; a subsequent stroke may therefore be circumstantial or aggravated, but not initiated, by cSMT.…”

Section: Discussionmentioning

confidence: 99%

The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation

et al. 2008

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In prior studies which identified vertebral artery compromise, those with a history of cSMT were more likely to have involvement of the V3 segment. Although this study does not identify a mechanism which relates vertebral artery dissection and exposure to cSMT, these data are compatible with a greater than additive relation between compromise of an arterial segment thought to be mechanically vulnerable and history of a mechanical event.

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Defining the Effect of Cervical Manipulation on Vertebral Artery Integrity: Establishment of an Animal Model

Cited by 8 publications

References 47 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Effect of Cervical Spine Manipulation on a Pre-Existing Vascular Lesion within the Canine Vertebral Artery

The relation between the spatial distribution of vertebral artery compromise and exposure to cervical manipulation

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