Podcast
Questions and Answers
What percentage of cervical arterial dissection (CAD) cases involved minor mechanical trauma to the head or neck in the past month, as reported by Thomas et al (2015)?
What percentage of cervical arterial dissection (CAD) cases involved minor mechanical trauma to the head or neck in the past month, as reported by Thomas et al (2015)?
Individuals with CAD were 60 times more likely to have experienced trauma compared to the control group.
Individuals with CAD were 60 times more likely to have experienced trauma compared to the control group.
True (A)
What specific artery is involved in approximately 90% of CAD cases with minor mechanical trauma, according to Thomas et al. (2015)?
What specific artery is involved in approximately 90% of CAD cases with minor mechanical trauma, according to Thomas et al. (2015)?
vertebral basilar artery
The most common adverse effect of spinal manipulation is ______ injury.
The most common adverse effect of spinal manipulation is ______ injury.
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Match the potential risk/complication of spinal manipulation with its corresponding description:
Match the potential risk/complication of spinal manipulation with its corresponding description:
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What are the primary safety concerns related to manipulation?
What are the primary safety concerns related to manipulation?
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The Symons et al (2002) study found that high-velocity, low-amplitude thrust (HVLAT) manipulation produced enough force to disrupt a normal vertebral artery.
The Symons et al (2002) study found that high-velocity, low-amplitude thrust (HVLAT) manipulation produced enough force to disrupt a normal vertebral artery.
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According to Symons et al (2002), how much did HVLAT increase strain on the vertebral artery?
According to Symons et al (2002), how much did HVLAT increase strain on the vertebral artery?
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The Cassidy et al (2009) study compared individuals who had a stroke (cases) with a control group based on ______ and ______.
The Cassidy et al (2009) study compared individuals who had a stroke (cases) with a control group based on ______ and ______.
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Match the study with its key finding:
Match the study with its key finding:
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Which study replicated the findings of Cassidy et al (2009)?
Which study replicated the findings of Cassidy et al (2009)?
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The Cassidy et al (2009) study found a stronger association between PCP visits and stroke than between chiropractic visits and stroke.
The Cassidy et al (2009) study found a stronger association between PCP visits and stroke than between chiropractic visits and stroke.
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Why might patients with vertebral artery dissection seek care from chiropractors or PCPs before experiencing a stroke?
Why might patients with vertebral artery dissection seek care from chiropractors or PCPs before experiencing a stroke?
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Study Notes
Manipulation Safety
- The presentation focuses on the safety of manipulation techniques, specifically in physical therapy.
- Research suggests concerns regarding damage to vertebral and internal carotid arteries, fractures, and soft tissue damage.
- Questions regarding the safety of manipulation include: what are the risks, experiences with past manipulations, and whether the risks outweigh the benefits.
- A review of artery safety is included, highlighting anatomical structures relevant to manipulation, such as the vertebral and internal carotid arteries.
Research on Manipulation Safety
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Symons et al. (2002) studied cadavers to analyze strain on the vertebral artery during cervical range of motion (ROM) and high-velocity, low-amplitude thrust (HVLAT).
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ROM increased strain by 1.2% to 12.5%.
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HVLAT increased strain by 6.2%.
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Mechanical failure of the artery didn't occur until strains of 139-162% higher than at rest.
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The study concluded that HVLAT is unlikely to cause disruption to a normal vertebral artery.
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Cassidy et al. (2009) analyzed 818 cases of vertebrobasilar artery (VBA) strokes and 4 matched controls in each case.
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4% of stroke cases and controls saw a chiropractor within 30 days of the stroke.
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53% of cases and 30% of controls saw a PCP within 30 days of the stroke.
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Increased association seen between chiropractic care and stroke in those under 45 years.
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Increased association between PCP care and stroke in all ages.
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Patients with head and neck pain (due to vertebral artery dissection) seek care for those symptoms, preceding strokes in over 80% of cases.
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Similar conclusions were found in studies from Whedon et al. (2015) and Kosloff et al. (2015) with Medicare-age populations and US commercial/Medicare Advantage populations.
Screening for Manipulation Risks
- A thorough history is vital for identifying potential spinal manipulation risks
- Thomas et al (2015) found that 71% of cervical arterial dissection (CAD) cases and 57% of internal carotid artery (ICA) cases reported minor mechanical trauma to the head or neck in the last month.
- Individuals with CAD were approximately 60 times more likely to have reported prior trauma compared to controls.
- Understanding the typical pain patterns in CAD is crucial. Red flags in CAD require careful evaluation.
Red Flags
- A table detailing classic signs and symptoms of vertebrobasilar insufficiency (VBI) and associated neuroanatomy is included (Table 1)
- Related symptoms such as dizziness (including vertigo, giddiness, and lightheadedness), drop attacks, diplopia, dysarthria, dysphagia, ataxia, nausea, numbness, and nystagmus are listed as potential indicators.
Vertebral Artery Dissection (VAD)
- Table 2 details the presentations of vertebral artery dissection, noting that non-ischemic symptoms can precede ischemic events by days to weeks.
- Non-ischemic symptoms include ipsilateral posterior neck pain/occipital headache and C5/6 cervical root impairment (rare).
- Ischemic symptoms include hind-brain TIA (dizziness, diplopia, dysarthria related to swallowing difficulties, drop attacks, nausea, nystagmus, and facial numbness), ataxia, headache, vomiting.
Internal Carotid Artery Dissection
- Table 3 details clinical features of internal carotid artery (ICA) dissection.
- Non-ischemic symptoms include Horner's syndrome, pulsatile tinnitus, and cranial nerve palsies (most commonly CN IX to XII).
- Ischemic symptoms include TIA, ischemic stroke (usually middle cerebral artery territory), retinal infarction, and amaurosis fugax.
Other Safety Considerations
- Data on fracture risk with manipulation is limited, primarily based on case studies/case series.
- Osteoporosis/osteopenia is a contraindication for manipulation due to higher fracture risk in certain areas (i.e., C-spine is less force than T-spine or L-spine).
- Different techniques and forces are associated with risk.
- Soft tissue injury is a common adverse effect of manipulation.
- Cleland et al (2009) reported that approximately 25% of patients experienced adverse effects (aggravation of symptoms, spasm, stiffness) within 4 hours of lumbar spine manipulation that resolved within 48 hours.
Summary Questions about Manipulation
- The presentation concludes with questions about the value of manipulation, whether the risks outweigh the benefits.
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Description
This quiz explores the safety of manipulation techniques used in physical therapy, focusing on potential risks such as damage to vertebral and internal carotid arteries. It evaluates research findings on strains during cervical range of motion and high-velocity, low-amplitude thrusts. Participants will assess their understanding of the risks and benefits associated with manipulation procedures.
