scholarly journals Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation

2021 ◽  
Author(s):  
Lindsay Gorrell ◽  
Gregor Kuntze ◽  
Janet L Ronsky ◽  
Ryan Carter ◽  
Bruce Symons ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Head Rotation ◽  
Time Profile ◽  
Camera Motion ◽  
Lateral Flexion ◽  
Flexion Extension ◽  
Cervical Spine Manipulation ◽  
Length Changes ◽  
Angular Displacements

Abstract Background Cervical spine manipulation (CSM) is a frequently used treatment for neck pain. Despite its demonstrated efficacy, concerns regarding CSM safety remain. The purpose of this study was to quantify the angular displacements of the head relative to the sternum and the associated vertebral artery (VA) length changes during the thrust phase of CSM. Methods Bilateral rotation and lateral flexion CSM procedures were delivered from C1 to C7 to three male cadaveric donors. For each CSM the force-time profile was recorded using a thin, flexible pressure pad (100-200Hz), to determine the timing of the thrust. Three dimensional displacements of the head relative to the sternum were recorded using an eight-camera motion analysis system (120-240Hz) and angular displacements of the head relative to the sternum were computed in Matlab. Positive kinematic values indicate flexion, left lateral flexion, and left rotation. Ipsilateral refers to the same side as the clinician's contact and contralateral, the opposite. Length changes of the VA were recorded using eight piezoelectric ultrasound crystals, inserted along the entire vessel. VA length changes were calculated as D=(L1-L0)/L0, where L0= length of the whole VA (sum of segmental lengths) or the V3 segment at CSM thrust onset; L1= whole VA or V3 length at peak force during the CSM thrust. Results VA length changes during the thrust phase were greatest with ipsilateral rotation CSM (producing contralateral head rotation): [mean ± SD (range)] whole artery [1.3 ± 1.0 (-0.4 to 3.3%)]; and V3 segment [2.6 ± 3.6 (-0.4 to 11.6%)]. For ipsilateral rotation CSM, head angular displacements relative to the sternum during the thrust were: flexion/extension [1.2 ± 3.4 (-6.6 to 7.6º)]; rotation [-10.2 ± 3.5 (-16.1 to -3.7º)]; and lateral flexion [8.8 ± 3.0 (2.5 to 14.1º)]. Conclusion Mean head angular displacements and VA length changes were small during CSM thrusts. Of the four different CSM measured, mean VA length changes were largest during rotation procedures. This suggests that if clinicians wish to limit VA length changes, consideration should be given to the type of CSM used.

scholarly journals Examining the Range of Motion of the Cervical Spine: Utilising Different Bedside Instruments

2021 ◽  
Vol 28 (2) ◽  
pp. 100-105
Author(s):  
Aiman Asyraf Ahmad Sukari ◽  
Sarwinder Singh ◽  
Muhammad Hafiz Bohari ◽  
Zamzuri Idris ◽  
Abdul Rahman Izaini Ghani ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Range Of Motion ◽  
Clinical Examination ◽  
Lateral Flexion ◽  
Range Of Movement ◽  
Cervical Range Of Motion ◽  
Accuracy And Precision ◽  
Flexion Extension ◽  
Measuring Tape ◽  
Examination Techniques

Background: This paper outlines a summary of examination technique to identify the range of movement of the cervical spine. Due to common difficulties in obtaining tools for cervical examination within the district, a standardised compilation of easy-to-replicate examination techniques are provided using different tools. Methods: Bedside instruments that can be used includes a measuring tape, compass, goniometer, inclinometer and cervical range of motion (CROM) instrument. Discussion: Cervical flexion-extension, lateral flexion and rotation will be assessed with bedside instruments. This would aid in increasing accuracy and precision of objective measurement while conducting clinical examination to determine the cervical range of motion.

scholarly journals Occlusion of Vertebral Artery, Cerebellar Infarction and Obstructive Hydrocephalus following Cervical Spine Manipulation

2007 ◽  
Vol 58 (4) ◽  
pp. 248-250 ◽  
Author(s):  
Denis Cerimagic ◽  
Josip Glavic ◽  
Arijana Lovrencic-Huzjan ◽  
Vida Demarin
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Obstructive Hydrocephalus ◽  
Cerebellar Infarction ◽  
Cervical Spine Manipulation

In vivo 3D kinematic changes in the cervical spine after laminoplasty for cervical spondylotic myelopathy

2014 ◽  
Vol 21 (3) ◽  
pp. 417-424 ◽  
Author(s):  
Yukitaka Nagamoto ◽  
Motoki Iwasaki ◽  
Tsuyoshi Sugiura ◽  
Takahito Fujimori ◽  
Yohei Matsuo ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Spondylotic Myelopathy ◽  
Head Rotation ◽  
Upper Cervical Spine ◽  
Registration Method ◽  
Flexion Extension ◽  
Upper Cervical ◽  
Head Flexion ◽  
Age Range

Object Cervical laminoplasty is an effective procedure for decompressing the spinal cord at multiple levels, but restriction of neck motion is one of the well-known complications of the procedure. Although many authors have reported on cervical range of motion (ROM) after laminoplasty, they have focused mainly on 2D flexion and extension on lateral radiographs, not on 3D motion (including coupled motion) nor on precise intervertebral motion. The purpose of this study was to clarify the 3D kinematic changes in the cervical spine after laminoplasty performed to treat cervical spondylotic myelopathy. Methods Eleven consecutive patients (6 men and 5 women, mean age 68.1 years, age range 57–79 years) with cervical spondylotic myelopathy who had undergone laminoplasty were included in the study. All patients underwent 3D CT of the cervical spine in 5 positions (neutral, 45° head rotation left and right, maximum head flexion, and maximum head extension) using supporting devices. The scans were performed preoperatively and at 6 months after laminoplasty. Segmental ROM from Oc–C1 to C7–T1 was calculated both in flexion-extension and in rotation, using a voxel-based registration method. Results Mean C2–7 flexion-extension ROM, equivalent to cervical ROM in all previous studies, was 45.5° ± 7.1° preoperatively and 35.5° ± 8.2° postoperatively, which was a statistically significant 33% decrease. However, mean Oc–T1 flexion-extension ROM, which represented total cervical ROM, was 71.5° ± 8.3° preoperatively and 66.5° ± 8.3° postoperatively, an insignificant 7.0% decrease. In focusing on each motion segment, the authors observed a statistically significant 22.6% decrease in mean segmental ROM at the operated levels during flexion-extension and a statistically insignificant 10.2% decrease during rotation. The most significant decrease was observed at C2–3. Segmental ROM at C2–3 decreased 24.2% during flexion-extension and 21.8% during rotation. However, a statistically insignificant 37.2% increase was observed at the upper cervical spine (Oc–C2) during flexion-extension. The coupling pattern during rotation did not change significantly after laminoplasty. Conclusions In this first accurate documentation of 3D segmental kinematic changes after laminoplasty, Oc–T1 ROM, which represented total cervical ROM, did not change significantly during either flexion-extension or rotation by 6 months after laminoplasty despite a significant decrease in C2–7 flexion-extension ROM. This is thought to be partially because of a compensatory increase in segmental ROM at the upper cervical spine (Oc–C2).

scholarly journals Fusion for subaxial bow hunter’s syndrome results in remote osseous remodeling of the hyperostotic growth responsible for vertebral artery compression

2021 ◽  
Vol 12 ◽  
pp. 104
Author(s):  
Daniel Satoshi Ikeda ◽  
Charles A. Miller ◽  
Vijay M. Ravindra
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Complete Resolution ◽  
Dynamic Compression ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Head Rotation ◽  
Vertebrobasilar Insufficiency ◽  
The Right ◽  
Vertebral Artery Compression ◽  
Hunter's Syndrome

Background: The authors present a previously unreported case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) who developed bow hunter’s syndrome (BHS) or positional vertebrobasilar insufficiency. In addition, the authors demonstrate angiographic evidence of remote osseous remodeling after segmental fusion without direct decompression of the offending bony growth. BHS is a rare, yet well established, cause of posterior circulation ischemia and ischemic stroke. Several etiologies such as segmental instability and spondylosis have been described as causes, however, DISH has not been associated with BHS before this publication. Case Description: A 77-year-old man who presented with BHS was found to have cervical spine changes consistent with DISH, and angiography confirmed right vertebral artery (VA) stenosis at C4–5 from a large pathological elongation of the right C5 lateral mass. Head rotation resulted in occlusion of the VA. The patient underwent an anterior cervical discectomy and fusion and reported complete resolution of his symptoms. A delayed angiogram and CT of the cervical spine demonstrated complete resolution of the baseline stenosis, no dynamic compression, and remote osseous remodeling of the growth, respectively. Conclusion: This case represents the first publication in the literature of DISH as a causative etiology of BHS and of angiographic data demonstrating resolution of a compressive osseous pathology without direct decompression in BHS.

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