Negative pre-manipulative vertebral artery testing despite complete occlusion: a case of false negativity?

Autor: Peter D. Milburn, Cathy Chapple, Darren A. Rivett
Rok vydání: 1998
Předmět:
Zdroj: Manual Therapy. 3:102-107
ISSN: 1356-689X
DOI: 10.1016/s1356-689x(98)80026-x
Popis: The application of manipulative or high velocity thrust procedures to cervical spinal joints is associated with a very low risk of neurovascular compromise (Dabbs & Lauretti 1995; Hurwitz et al 1996; Rivett 1997; Shekelle & Coulter 1997). Although the actual incidence rate is yet to be conclusively determined, there is consensus in the literature that iatrogenic accidents of this type are rare. Despite the infrequency of these incidents, the potentially lethal or disabling outcomes have prompted professional bodies to recommend clinical pre-manipulative protocols to screen for patients at risk of stroke following neck manipulations (APA 1988; Grant 1996). Cervical spine positional tests are commonly recommended which utilize extension, rotation and/or some combination thereof (Aspinall 1989; Grant 1994). The rationale of the tests is that vertebral artery blood flow may be compromised by mechanical stresses related to these positions, particularly at the atlanto-axial segment, leading to the clinical manifestation of signs and symptoms of vertebrobasilar insufficiency (VBI) (Brown & Tatlow 1963; Grant 1994; Refshauge 1994). A patient demonstrating a possible ischaemic response to testing is deemed unsuitable for cervical manipulative treatment, whereas a negative response indicates it is appropriate to perform neck manipulation (APA 1988). However, the validity of the positional tests in detecting patients at risk of stroke is the subject of increasing controversy and research (Kunnasmaa & Thiel 1994; Refshauge 1994; Thiel et al 1994; C6t6 et al 1996
Databáze: OpenAIRE
Externí odkaz: