Effects of Spinal Manipulation on Vertebrobasilar and Internal Carotis Arteries in Healthy Population

Neck Pain Clinical Trial

Official title:

Comparison the Effects of Manual and Instrumental Chiropractic Spinal Manipulation on Vertebrobasilar and Internal Carotis Arteries in Healthy Population

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03435159
• Other study ID #: BahcesehirUni
• Status: Completed
• Phase: N/A
• First received: January 3, 2018
• Last updated: February 14, 2018
• Start date: February 17, 2017
• Est. completion date: April 28, 2017

Study information

• Verified date: February 2018
• Source: Bahçesehir University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 30
• Est. completion date: April 28, 2017
• Est. primary completion date: April 28, 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 20 Years to 40 Years

Eligibility

Inclusion Criteria:

• Being between 20-40 years of age

• Having non-specific mechanical neck pain for more than 3 months with symptoms provoked by neck postures, movements, or palpation

• Willingly participating to the study

• Signing the confirmation form.

Exclusion Criteria:

• Spinal root compression (radiculopathy)

• Neurological symptoms like weakness and numbness in extremities and face, uncontrolled movements, abnormal gait, dizziness, undefined nausea/vomiting, swallowing and speaking difficulties

• Acute inflammatory disease

• Spontaneously vertebral artery dissection in family

• Tested positive in premanipulative vertebrobasilar artery insufficiency test

• Being on anticoagulant and antiaggregant medication.

Related Conditions & MeSH terms

• Aneurysm, Dissecting
• Neck Pain
• Vertebral Artery Dissection
• Vertebral Artery Dissection, Traumatic

Intervention

Diagnostic Test:
• Doppler Ultrasonography
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.

Procedure:
• Manual Chiropractic Spinal Manipulation
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.

Device:
• Instrumental Chiropractic Spinal Manipulation
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.

Locations

Country	Name	City	State
Turkey	Maslak Acibadem Hospital	Istanbul

Sponsors (1)

Lead Sponsor	Collaborator
Bahçesehir University

Country where clinical trial is conducted

Turkey, 

References & Publications (3)

Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study. Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S176-83. doi: 10.1097/BRS.0b013e3181644600. Erratum in: Spine (Phila Pa 1976). 2010 Mar 1;35(5):595. — View Citation

Gemmell H, Miller P. Comparative effectiveness of manipulation, mobilisation and the activator instrument in treatment of non-specific neck pain: a systematic review. Chiropr Osteopat. 2006 Apr 19;14:7. — View Citation

Gemmell H, Miller P. Relative effectiveness and adverse effects of cervical manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results from a stopped randomised trial. Chiropr Osteopat. 2010 Jul 9;18:20. doi: 10.1186/1746-1340-18-20. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Peak Systolic Velocity (PSV)	cm/s, measured in each group	1 minute
Primary	Change in End Diastolic Velocity (EDV)	cm/s, measured in each group	1 minute
Primary	Change in Resistive Index (RI)	The Formula: RI = (PSV- EDV) / PSV, it has no unit, measured in each group	1 minute
Primary	Change in Volume Flow (VF)	ml/min, measured only for right and left vertebral arteries	1 minute