Ultrasound analysis of the vertebral artery during non-thrust cervical translatoric spinal manipulation

Abstract

Objective: Cervical translatoric spinal manipulation (TSM) techniques have been suggested as a safer alternative to cervical thrust rotatory techniques. The objective of this study was to determine the effect of three C5–C6 non-thrust TSM techniques on vertebral artery (VA) lumen diameter (LD) and two blood flow velocity parameters. The two-tailed research hypothesis was that the TSM techniques would result in a significant change (increase or decrease) in blood flow velocity and arterial LD at the C5–C6 intertransverse portion of the VA.

Methods: In a sample of 30 subjects representative of a clinical population, color-coded duplex Doppler diagnostic ultrasound imaging was used to collect data on LD, peak systolic velocity (PSV), and end diastolic velocity with the cervical spine positioned in neutral and in three different manipulation positions. Pair-wise mean differences between measurements at baseline (neutral position) and in all three manipulation positions were analyzed using two-tailed paired t-tests with alpha set at 0·05.

Results: Of the 18 paired comparisons, there were four statistically significant differences between measurements in the neutral position and a manipulation position, three concerning LD and one PSV.

Discussion: The three significant differences in LD ranged from 4·6 to 3·2% and were not associated with changes in blood flow velocity. The one significant change in PSV was only 6·6 cm/s. A value that still greatly exceeded the end diastolic velocity. No subject experienced symptoms associated with VA compromise. This study has provided evidence for the safety of the three lower cervical non-thrust TSM techniques on the current population studied. Further study is required on thrust versus non-thrust TSM techniques and on levels other than C5–C6.

Keywords:

• Translatoric spinal manipulation
• Cervical spine
• Color-coded duplex Doppler diagnostic ultrasound imaging
• Blood flow velocity
• Lumen diameter

This paper is dedicated with deep respect to Peter Huijbregts, co-author. Peter’s knowledge of statistics, passion for manual therapy, and willingness to collaborate with manual therapists from all schools of thought have left an indelible positive impression on us all.