Podcast
Questions and Answers
What percentage of vertebrobasilar artery (VBA) cervical arterial dissection (CAD) cases reported minor mechanical trauma in the last month?
What percentage of vertebrobasilar artery (VBA) cervical arterial dissection (CAD) cases reported minor mechanical trauma in the last month?
Individuals with cervical arterial dissection (CAD) are how many times more likely to have experienced trauma compared to the control group?
Individuals with cervical arterial dissection (CAD) are how many times more likely to have experienced trauma compared to the control group?
What type of spine manipulation is reported to resolve adverse effects within 48 hours according to Cleland et al (2009)?
What type of spine manipulation is reported to resolve adverse effects within 48 hours according to Cleland et al (2009)?
Which of the following statements regarding fracture risk with manipulation is correct?
Which of the following statements regarding fracture risk with manipulation is correct?
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What is considered a red flag in cervical arterial dissection (CAD)?
What is considered a red flag in cervical arterial dissection (CAD)?
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What is a common safety concern associated with manipulation therapy?
What is a common safety concern associated with manipulation therapy?
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According to Symons et al (2002), what was concluded about the risk of HVLAT causing vertebral artery damage?
According to Symons et al (2002), what was concluded about the risk of HVLAT causing vertebral artery damage?
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In the Cassidy et al (2009) study, which age group showed an increased association between visiting a chiropractor and experiencing a stroke?
In the Cassidy et al (2009) study, which age group showed an increased association between visiting a chiropractor and experiencing a stroke?
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What percentage of cases and controls in the Cassidy et al (2009) study saw a chiropractor within 30 days of the stroke?
What percentage of cases and controls in the Cassidy et al (2009) study saw a chiropractor within 30 days of the stroke?
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What factor, according to the findings, often precedes more than 80% of vertebrobasilar artery strokes?
What factor, according to the findings, often precedes more than 80% of vertebrobasilar artery strokes?
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What study evaluated strain on the vertebral artery in cadavers during cervical ROM and HVLAT?
What study evaluated strain on the vertebral artery in cadavers during cervical ROM and HVLAT?
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What did Whedon et al 2015 conclude in their study on manipulation safety with Medicare aged population?
What did Whedon et al 2015 conclude in their study on manipulation safety with Medicare aged population?
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According to the research, which practice showed an increased association with stroke at all ages?
According to the research, which practice showed an increased association with stroke at all ages?
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Study Notes
Manipulation Safety
- Manipulation safety research is the focus
- Risks and benefits of manipulation are crucial considerations
- Potential risks include damage to the vertebral and internal carotid arteries, fractures, and soft tissue damage.
Is Manipulation Safe?
- Questions about the risks of manipulation are raised
- Personal experiences with manipulation are examined
- The balance between risks and benefits is questioned
Safety Concerns
- Research concerns generally center around potential damage to the vertebral and internal carotid arteries.
- Fractures and soft tissue damage are also noted as concerns.
Artery Safety
- Artery safety focuses on the importance of understanding artery anatomy for safe manipulation.
Anatomy Review
- The anatomy of the vertebral arteries is presented through diagrams.
Evidence
- Symons et al (2002) study assessed cervical spine ranges of motion and high-velocity, low-amplitude thrusts (HVLAT) on vertebral artery strain in cadavers
- Results indicated minor strain increases with ROM and HVLAT, but no mechanical failure of the artery was found until significant (139-162%) strain, suggesting safety with a typical range.
Cassidy et al (2009)
- Examined databases for 818 vertebrobasilar artery (VBA) stroke cases.
- Age and sex-matched controls are utilized in this study.
- Cases were compared to controls to determine if patients had seen a chiropractor or PCP in the 7 or 30 days prior to the stroke.
- A correlation was found between chiropractic care and stroke if age was under 45.
- A stronger correlation was also found between general PCP visits and stroke among all ages.
Replication
- Whedon et al (2015) and Kosloff et al (2015) replicated earlier studies in other populations,
- Reaching the same conclusions about the effect of chiropractic care on VBA strokes in the Medicare and US commercial populations.
Screening
- A thorough history is crucial for effective screening.
- Thomas et al (2015) note that 71% of cervical arterial dissection (CAD) cases (90% VBA and 57% ICA) had reported minor head/neck trauma in the prior month.
- Patients with CAD were significantly more likely to have reported recent trauma compared to controls.
- Understanding patterns of neck pain associated with CAD and screening for red flags are further highlighted
Red Flags - Considerations
- Table 1 details classic signs and symptoms of possible vertebrobasilar insufficiency (VBI) with associated neuroanatomy.
- It lists various associated neuroanatomy components related to each sign, like dizziness (lower vestibular nuclei) , and drop attacks (reticular formation).
VAD
- Table 2 details possible non-ischemic and ischemic signs and symptoms of vertebral artery dissection (VAD).
Internal Carotid Artery Dissection
- Table 3 presents clinical features of ICA dissection, including both non-ischemic and ischemic signs and symptoms.
- This table also notes that non-ischemic symptoms precede ischemic (cerebral or retinal) symptoms in ICA dissection, similar to other conditions.
Other Safety Considerations
- Data regarding fracture risk related to manipulation is limited to mostly case studies and series.
- Osteoporosis or osteopenia are contraindications to certain manipulation techniques due to higher risk.
- C-spine manipulation offers less risk than T-spine or L-spine manipulation.
- Different manipulation techniques create different forces
Soft Tissue Injury
- Soft tissue injuries are the most common adverse effect of manipulation.
- Cleland et al (2009) reported 25% of patients experienced adverse effects (such as spasm, stiffness, aggravation of symptoms) within 4 hours of lumbar spine manipulation, resolving by 48 hours.
Is Manipulation Safe? - Revisited
- A final consideration of whether manipulation risks outweigh benefits is presented, emphasizing the need for careful evaluation of patient cases.
Objectives - Revisited
- Research on manipulation safety remains an ongoing area of study.
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Description
This quiz explores the critical aspects of manipulation safety, focusing on the risks and benefits associated with manipulation techniques. Topics include potential damage to arteries, fractures, and soft tissue concerns, as well as the importance of understanding anatomy for safe practices. Personal experiences and research findings are also examined.
