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Carotid artery blood flow during premanipulative testing.
Peter B Licht1, Henrik W Christensen, Poul F Høilund-Carlsen
1Department of Clinical Physiology and Nuclear Medicine, Odense University Hospital, Denmark.
Journal of Manipulative and Physiological Therapeutics
|December 6, 2002
Summary
Premanipulative testing for cervical manipulation does not appear to reliably detect patients at risk of cerebrovascular accidents (CVAs). Studies show no significant changes in carotid or vertebral artery blood flow with head positioning in patients with positive tests.
Area of Science:
- Neurology
- Vascular Medicine
- Chiropractic Medicine
Background:
- Cervical manipulation is a common procedure with rare reported cerebrovascular accidents (CVAs).
- Premanipulative tests are traditionally used to identify patients at risk of CVAs.
- Previous research found no significant changes in vertebral artery blood flow with head positioning in patients with positive premanipulative tests.
Purpose of the Study:
- To investigate if blood flow velocity in internal carotid arteries changes with head position in patients exhibiting a positive premanipulative test.
- To determine if positive premanipulative tests indicate a potential contraindication for cervical manipulation due to vascular compromise.
Main Methods:
- A prospective study involving chiropractors referring patients with positive premanipulative tests.
- Measurement of blood flow velocities in vertebral and internal carotid arteries using color duplex sonography.
- Examination of flow velocities in both arteries with varying head positions.
Main Results:
- Nine patients with positive premanipulative tests completed the study; two were excluded due to irreproducible symptoms.
- No significant differences were observed in peak or time-averaged mean flow velocities in the internal carotid arteries with different head positions.
- Blood flow in the internal carotid arteries did not cease in any patient despite positive premanipulative tests.
Conclusions:
- A positive premanipulative test is not associated with alterations in carotid or vertebral artery blood flow velocity.
- Premanipulative testing may have limited clinical value for detecting vascular insufficiency as a precursor to CVAs following cervical manipulation.