The Complexity of Trauma to the Cranio-Cervical Junction: Correlation of Clinical Presentation with Doppler Flow Velocities in the V3-Segment of the Vertebral Arteries

Reddy, Marion; Reddy, Bhaskar; Schöggl, Andreas; Saringer, Walter; Matula, Ch.

doi:10.1007/s007010200078

Cited by 19 publications

(8 citation statements)

References 30 publications

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“…however, it has been proposed also that the natural tortuosity The JourNAl oF mANuAl & mANiPulATiVe TherAPy n Volume 17 n Number 1 [47] VErTEBrAL ArTEry BLood fLow VELoCiTy CHANgES ASSoCiATEd wiTH CErViCAL SPiNE roTATioN of the VA between the first and second vertebrae should prevent much of this apparent distortion of the vessel 35,51,53 . In addition, mechanical compression and/ or stretching of the VA is more likely to occur to its suboccipital part, on fullrange cervical spine rotation, as it passes through the transverse foramen and along the posterior arch 47,48,[54][55][56][57][58][59][60] , or around the bony lateral mass of the atlas vertebra 39,43,48,49,51,[59][60][61][62][63] , where it is bound down by connective tissue 16,22,35,39,43,59,64 ( Figure 1).…”

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confidence: 99%

Vertebral Artery Blood flow Velocity Changes Associated with Cervical Spine rotation: A Meta-Analysis of the Evidence with implications for Professional Practice

Mitchell

2009

Journal of Manual & Manipulative Therapy

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Many studies of vertebral artery (VA) blood flow changes related to cervical spine rotation have been published, but the findings are controversial and the evidence unconvincing. Recent Doppler measurements suggest that contralateral VA blood flow is compromised on full rotation in both healthy subjects and patients. More rigorous research is needed, and it was the aim of this study to conduct a meta-analysis of published data to inform professional practice. A systematic literature search, including only Doppler studies of VA blood flow velocity associated with cervical spine rotation in adults, yielded nine reports with published data. Using weighted means of the pooled data, the magnitude of the effect size (Cohen's d) was calculated for differences between patients and subjects, sitting or lying supine for testing, the parts of the VA insonated, and the changes recorded after cervical spine rotation. From this meta-analysis, VA blood flow velocity was found to be compromised more in patients than healthy individuals, on contralateral rotation, with the subject sitting, and more in the intracranial compared to the cervical part of the VA. Possible reasons for these findings are suggested, and it is advised that sustained end-of-range rotation and quick-thrust rotational manipulations be avoided until there is a stronger evidence base for clinical practice.

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confidence: 99%

Vertebral Artery Blood flow Velocity Changes Associated with Cervical Spine rotation: A Meta-Analysis of the Evidence with implications for Professional Practice

Mitchell

2009

Journal of Manual & Manipulative Therapy

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“…It is as this point where the artery is thought to be most susceptible to injury related to sudden or extreme head movement. 4 The atlantal segment is enclosed in a muscular sheath and passes through a groove behind the C1 articular process before entering the cranium through the atlantooccipital membrane and the dura mater. The VA is fixed to the inner surface of the tunnel formed by the transverse foramina by a continuous layer of collagen.…”

Section: Anatomy Of the Cervical Arteriesmentioning

confidence: 99%

The etiology of cervical artery dissection

Haneline

Rosner

2007

Journal of Chiropractic Medicine

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The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. The analysis of CAD risk factors is confusing, however, because many people are exposed to mechanical events and known pathophysiological associations without ever experiencing dissection. No cause-and-effect relationship has been established between cervical spine manipulation and CAD, but it seems that cervical manipulation may be capable of triggering dissection in a susceptible patient or contributing to the evolution of an already existing CAD. Despite the many risk factors that have been proposed as possible causes of CAD, it is still unknown which of them actually predispose patients to CAD after cervical spine manipulation.

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“…Another benefit of CTA is shorter scan time compared with DSA and MRA. 35 TREATMENT Treatment of VAI in the setting of blunt cervical spine trauma continues to be an area of controversy. A reported concern associated with CTA is the risk of malignancy from radiation exposure from multichannel detectors, particularly the newest 64-slice scanners.…”

Section: Jang Et Al 2011mentioning

confidence: 99%

Vertebral Artery Injuries and Blunt Cervical Trauma

Aguwa

Behr

et al. 2013

Contemporary Spine Surgery

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VOLUME 14 ■ NUMBER 5 ■ MAY 2013 the transverse foramen, typically at the C6 level. There, the artery ascends through the transverse foramen of the cervical vertebrae until the C1 level, where the artery exits the transverse foramen and winds posteromedially around the lateral mass and posterior arch of the atlas before piercing the dura of the spinal cord.The vertebral artery enters the base of the skull at the foramen magnum, joining its contralateral artery, forming the basilar artery and posterior circulation of the brain. Anterior branches from the vertebral artery are given off at the level of the foramen magnum to form the anterior spinal artery, supplying the majority of the spinal cord. Further vascularization to the spinal cord comes from the segmental arteries at the level of each cervical vertebra.Studies have shown that one vertebral artery usually predominates in circulationthe left in up to 75% of patients. Although the incidence of bilateral VAI in patients with blunt cervical spine trauma has been reported to be as high 25%, 19 compared with the right vertebral artery, unilateral left-sided injury is, in theory, associated with greater risk of neurologic compromise. Blunt traumatic VAI is most likely to occur while the artery courses through the transverse foramen. 4

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The Complexity of Trauma to the Cranio-Cervical Junction: Correlation of Clinical Presentation with Doppler Flow Velocities in the V3-Segment of the Vertebral Arteries

Cited by 19 publications

References 30 publications

Vertebral Artery Blood flow Velocity Changes Associated with Cervical Spine rotation: A Meta-Analysis of the Evidence with implications for Professional Practice

Vertebral Artery Blood flow Velocity Changes Associated with Cervical Spine rotation: A Meta-Analysis of the Evidence with implications for Professional Practice

The etiology of cervical artery dissection

Vertebral Artery Injuries and Blunt Cervical Trauma

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