Effects of Spinal Manipulation on Vertebrobasilar and Internal Carotis Arteries in Healthy Population
Condition: Vertebral Artery Dissection, Traumatic; Neck Pain
MeSH terms: Vertebral Artery Dissection; Neck Pain
Study type: Interventional

Summary: 
      After lumbar pain, neck pain is the most common cause of patients needing chiropractic care;
      the second most common cause of spinal manipulation use (1). Manipulation and mobilization
      are commonly used by chiropractors, osteopaths and manipulative physiotherapists in the
      treatment of neck pain. Many studies show that the Activator instrument is also used for this
      purpose in the chiropractic profession (2) There are several published case reports that
      relate to neck manipulation to vertebral artery dissection and stroke. The prevailing theory
      is that the neck extension and / or rotation may damage the vertebral artery in the foramen
      transversarium, especially at the C1-C2 level (2). However, most cases of extracranial
      vertebral artery dissection are thought to be spontaneous (3).

      In the literature, there have been no studies investigating the effects of
      instrument-assisted spinal manipulation on vertebrobasilar and internal carotis arteries. the
      aim of this study to compare the effect of manual and instrumental spinal manipulation on
      blood flow parameters of vertebrobasilar and internal carotis arteries on healthy persons
      which have mechanical neck pain and asymptomatic in vertebrobasilar insufficiency test.
    


Intervention name(s): Doppler Ultrasonography; Manual Chiropractic Spinal Manipulation; Instrumental Chiropractic Spinal Manipulation
Intervention type(s): Diagnostic Test; Procedure; Device
Intervention description(s): GE LOGIQ S8 ultrasound machine was used to measure blood flow parameters in right and left a. carotis communis, a. carotis interna and a. vertebralis. All vessels were examined in the axial plane through their traces in the B-mode with a C6-15 MHz curvilinear matrix probe. Flow patterns and directions of vessels were then examined with Colour Doppler and it was determined whether there was any stenosis. Intimal thickness of a. carotis communis was measured by spectral doppler method. Measurements were recorded by visualizing the CCA at the supraclavicular level, the ICA carotid sinus (C4 level), and the VA at the V2 segment (C3-4 level), with less angle at 60 degrees. All measurements before and after the application were made at the same level. Immediately after manipulation, blood flow parameters were recorded as numerical data by the same physician again with Doppler USG of the relevant arteries.; Manipulation procedures were applied to C1 or C2 (atlas and axis) vertebrae once in each participant. The application to which vertebrae were applied was determined by the palpation method applied by the physiotherapist. Manual chiropractic manipulation for C1 vertebra was applied in sitting position, using the "digit / atlas pull" technique. This technique is applied with the contact of practitioner's middle finger to the posterior part of transverse process of atlas, and generate a rotation force between C1 and C2 vertebrae.
The procedure was applied to C2 vertebra using the "index / facet push" technique in the supine position. This technique places pushing force in the direction of rotation between the C2-C3 vertebrae, placing the practitioner's index finger in contact with the posterior surface of the C2 facet joint.; Activator technique was applied to C1 or C2 (atlas and axis) vertebrae once in each participant. The application to which vertebrae were applied was determined by the palpation method applied by the physiotherapist. Instrumental spinal manipulation was applied with Activator V chiropractic instrument. For C1 vertebra, the procedure was applied in supine position, by placing the Activator device horizontally on the participant's atlas transverse process of the affected side and applying a pushing force in the medial direction.
For C2 vertebra, the procedure was applied in prone position, by placing the Activator device in the relevant C2 pedicle-lamina junction of the participant's affected side and applying a pushing force in the anterior, superior and mild medial direction of movement of the facet joint.
Other intervention name(s): Activator technique
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 30 participants were divided into 2 groups. In the first group, participants were applied manual chiropractic manipulation, and in the second group, participants were applied instrumental chiropractic manipulation.
Masking: Single (Outcomes Assessor)
Primary purpose: Screening
Keywords: Chiropractic, Manipulation, Vertebrobasilar Artery