Podcast
Questions and Answers
What percentage of Cervical Arterial Dissection (CAD) cases, as reported by Thomas et al. (2015), involved minor mechanical trauma to the head or neck in the month preceding the event?
What percentage of Cervical Arterial Dissection (CAD) cases, as reported by Thomas et al. (2015), involved minor mechanical trauma to the head or neck in the month preceding the event?
Individuals with Cervical Arterial Dissection (CAD) were found to be how many times more likely to have experienced trauma compared to a control group, according to the information presented?
Individuals with Cervical Arterial Dissection (CAD) were found to be how many times more likely to have experienced trauma compared to a control group, according to the information presented?
According to the provided information, what is the most common adverse effect associated with spinal manipulation?
According to the provided information, what is the most common adverse effect associated with spinal manipulation?
Cleland et al. (2009) reported that a certain percentage of patients experienced adverse effects after lumbar spine manipulation. What was the approximate percentage they reported?
Cleland et al. (2009) reported that a certain percentage of patients experienced adverse effects after lumbar spine manipulation. What was the approximate percentage they reported?
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Within what timeframe did the adverse effects reported by Cleland et al. (2009) following lumbar spine manipulation typically resolve?
Within what timeframe did the adverse effects reported by Cleland et al. (2009) following lumbar spine manipulation typically resolve?
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What type of data primarily informs the understanding of fracture risk associated with spinal manipulation, according to the provided text?
What type of data primarily informs the understanding of fracture risk associated with spinal manipulation, according to the provided text?
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Which of the following conditions is mentioned as a contraindication for spinal manipulation due to fracture risk?
Which of the following conditions is mentioned as a contraindication for spinal manipulation due to fracture risk?
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When comparing different regions of the spine, which area is indicated as being subjected to less force during manipulation?
When comparing different regions of the spine, which area is indicated as being subjected to less force during manipulation?
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Taylor and Kerry's (2010) approach to risk assessment of the cervical spine is described as:
Taylor and Kerry's (2010) approach to risk assessment of the cervical spine is described as:
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In the context of Cervical Arterial Dissection (CAD), the acronym 'Ns and Ds' is associated with:
In the context of Cervical Arterial Dissection (CAD), the acronym 'Ns and Ds' is associated with:
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What is generally considered the primary safety concern regarding spinal manipulation?
What is generally considered the primary safety concern regarding spinal manipulation?
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According to Symons et al (2002), what was the maximum percentage of strain increase observed in the vertebral artery during cervical High-Velocity Low-Amplitude Thrust (HVLAT) in cadavers?
According to Symons et al (2002), what was the maximum percentage of strain increase observed in the vertebral artery during cervical High-Velocity Low-Amplitude Thrust (HVLAT) in cadavers?
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Symons et al (2002) concluded that mechanical failure of a normal vertebral artery occurred at strain levels of:
Symons et al (2002) concluded that mechanical failure of a normal vertebral artery occurred at strain levels of:
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In the Cassidy et al (2009) study, what percentage of both stroke cases and control groups had seen a chiropractor within 30 days prior to a vertebrobasilar artery (VBA) stroke?
In the Cassidy et al (2009) study, what percentage of both stroke cases and control groups had seen a chiropractor within 30 days prior to a vertebrobasilar artery (VBA) stroke?
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According to Cassidy et al (2009), which group showed a higher percentage of seeking care from a Primary Care Physician (PCP) within 30 days prior to a VBA stroke?
According to Cassidy et al (2009), which group showed a higher percentage of seeking care from a Primary Care Physician (PCP) within 30 days prior to a VBA stroke?
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Cassidy et al (2009) observed an increased association between chiropractic visits and stroke specifically in which age demographic?
Cassidy et al (2009) observed an increased association between chiropractic visits and stroke specifically in which age demographic?
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What primary reason did Cassidy et al (2009) propose to explain the association between chiropractic or PCP visits and VBA stroke?
What primary reason did Cassidy et al (2009) propose to explain the association between chiropractic or PCP visits and VBA stroke?
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Which of the following best describes the nature of the studies by Whedon et al (2015) and Kosloff et al (2015) in relation to the findings of Cassidy et al (2009)?
Which of the following best describes the nature of the studies by Whedon et al (2015) and Kosloff et al (2015) in relation to the findings of Cassidy et al (2009)?
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According to the provided information, what precedes more than 80% of Vertebrobasilar Artery (VBA) strokes related to vertebral artery dissection?
According to the provided information, what precedes more than 80% of Vertebrobasilar Artery (VBA) strokes related to vertebral artery dissection?
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What is the next logical step in ensuring manipulation safety, following the understanding of research on potential risks?
What is the next logical step in ensuring manipulation safety, following the understanding of research on potential risks?
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Flashcards
Cervical Artery Dissection (CAD)
Cervical Artery Dissection (CAD)
A tear in the inner lining of an artery in the neck, often caused by a minor injury.
Vertebrobasilar Artery Dissection (VBA)
Vertebrobasilar Artery Dissection (VBA)
A type of CAD where the vertebral artery is affected.
Internal Carotid Artery Dissection (ICA)
Internal Carotid Artery Dissection (ICA)
A type of CAD where the internal carotid artery is affected.
Pattern of pain in CAD
Pattern of pain in CAD
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Red Flags in CAD
Red Flags in CAD
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System-Based Approach to Cervical Spine Risk Assessment
System-Based Approach to Cervical Spine Risk Assessment
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Osteoporosis/Osteopenia
Osteoporosis/Osteopenia
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Soft Tissue Injury
Soft Tissue Injury
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Manipulation Safety
Manipulation Safety
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Understanding the research on manipulation safety
Understanding the research on manipulation safety
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Vertebral Artery Safety
Vertebral Artery Safety
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HVLAT (High-Velocity, Low-Amplitude Thrust)
HVLAT (High-Velocity, Low-Amplitude Thrust)
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Cervical Range of Motion (ROM)
Cervical Range of Motion (ROM)
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Strain
Strain
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Symons et al. (2002)
Symons et al. (2002)
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Cassidy et al. (2009)
Cassidy et al. (2009)
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Screening
Screening
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Vertebrobasilar Artery (VBA) Stroke
Vertebrobasilar Artery (VBA) Stroke
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Vertebral Artery Dissection
Vertebral Artery Dissection
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Replication
Replication
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Study Notes
Manipulation Safety
- Manipulation safety research is the focus of this presentation.
- Potential risks include damage to vertebral and internal carotid arteries, fractures, and soft tissue damage.
- The presentation questions whether manipulation is safe and whether the risks outweigh the benefits.
- Research on manipulation safety is limited.
- Studies are frequently case studies or case series.
- A critical factor is osteoporosis/osteopenia, which is considered a contraindication for manipulation due to the increased fracture risk.
Artery Safety
- Cervical spine manipulation may increase strain on vertebral arteries.
- Strain ranges from 1.2% to 12.5% for ROM and up to 6.2% for HVLAT, but these levels often don't disrupt healthy arteries.
Anatomy Review
- Images of the cervical spine and arteries are used to visualize the area.
- The arrangement of arteries in the neck and relevant musculoskeletal structure is reviewed.
Evidence from Studies
- Symons et al (2002) studied cadavers and found minimal strain to vertebral arteries during cervical movements.
- Strain in healthy arteries during high-velocity, low-amplitude thrust manipulation (HVLAT) were found to be low and unlikely to induce damage.
- Cassidy et al (2009) reviewed stroke cases and controls to assess the correlation between chiropractic visits and stroke occurrences.
- A statistically significant association existed between chiropractic visits within 30 days of stroke.
- Those under 45 showed a stronger correlation than those over that age.
Replication of Findings
- Studies like Whedon et al (2015) and Kosloff et al (2015) replicated the findings on the aged Medicare population and similar results in US commercial and Medicare Advantage populations.
Screening
- Thorough history-taking is vital to screening for manipulation risks.
- Thomas et al. (2015) studied 71% of cervical arterial dissection cases, finding prior trauma to the head or neck in a significant portion of cases.
- Understanding the relevant pain patterns and red flags in cases of cervical artery dissection (CAD) is crucial for proper screening.
Red Flags and Dissections
- Table 1 lists classic signs and symptoms of vertebrobasilar insufficiency (VBI) and associated neuroanatomy.
- Table 2 outlines non-ischemic (local) and ischemic (cerebral or retinal) signs and symptoms potentially related to vertebral artery dissection (VAD).
- Table 3 presents clinical features of internal carotid artery dissection (ICA) and associated potential symptoms preceding ischemia.
Fracture Risk
- Data on fracture risk from manipulation is limited, primarily based on case studies.
- Osteoporosis/osteopenia makes manipulation a contraindication.
- Specific spinal regions (cervical spine) may have a lower risk compared to other areas (thoracic or lumbar spine).
- Different techniques lead to various forces.
Soft Tissue Injury
- Soft tissue injury is the most common adverse effect of manipulation, identified by some at 25% in Cleland et al (2009).
- Limited data exists for soft tissue injury after manipulation.
Overall Safety
- The presenter poses the question of: Do risks outweigh the benefits?
- Multiple studies show potential risks associated with manipulative procedures.
- A thorough evaluation of these potential risks is essential to inform treatment decisions that consider benefit vs risk.
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Description
This quiz focuses on the safety of manipulation in relation to the cervical spine and arteries. It discusses potential risks, including strains on vertebral arteries and considerations for individuals with osteoporosis. Additionally, it reviews anatomical structures and relevant studies on manipulation safety.
