Raymond Wiegand, DC; Normal Kettner, DC; Deborah Brahee, DC; Nelson Marquina, DC, PHD
Objective: To investigate whether a statistical correlation existed between lateral cervical geometry and cervical pathology, as identified on neutral anteroposterior (AP) and lateral radiographs within a symptomatic group; describe the cervical pathology and determine its location and frequency; and identify the subject's age, gender and chief complaint.
Setting: Department of radiology at a chiropractic college.
Methods: One hundred eighty-six consecutive pairs of AP and lateral cervical radiographs were reviewed for pathology. A five-category severity scale was used to describe degenerative joint disease (DJD), the most common pathological finding. The subject's age, gender and symptoms were recorded. Geometric analysis was focused on vertebral position, alignment and gravitational loading acquired from the neutral lateral cervical radiograph.
Results: Regression and discriminant analysis identified five geometric variables that correctly classified pathology subjects from nonpathology subjects 79% of the time. Those variables were: 1. forward flexion angle of the lower cervical curve; 2. gravitational loading on the C5 superior vertebral endplate; 3. horizontal angle of C2 measured from its inferior vertebral endplate; 4. disc angle of C3; and 5. posterior disc height of C5. DJD was the most common pathological finding identified within discrete-age, gender and symptom groups.
Conclusion: We identified five geometric variables from the lateral cervical spine that were predictive 79% of the time for cervical degenerative joint disease. Discrete-age, gender and symptom groups demonstrated an increased incidence of DJD.
Key indexing terms: Cervical vertebrae; joint diseases; radiography.
Changes in vertebral artery blood flow following normal rotation of the cervical spine.
Jeanette Mitchell
Background: Extreme rotation of the cervical spine may cause compromised vertebral artery (VA) blood flow. This is of particular interest to manual therapists because of the potential risks associated with these movements. The question is whether the decreased blood flow is significant, and therefore likely to cause vertebrobasilar insufficiency/ischemia (VBI), and whether contralateral and ipsilateral rotation are equally affected. Several studies measuring VA blood flow have been reported. However, different parts of the VA were studied, in small samples of normal subjects and patients, over a wide range of ages. Hence, the results are controversial.
Objective: To investigate intracranial VA blood flow in normal males and females, aged 20-30 years, in neutral and maximally rotated cervical spinal positions.
Methods: Transcranial Doppler sonography was used to measure intracranial VA blood flow with the cervical spine in neutral, then rotated maximally to the left and later to the right. The sample consisted of 60 males and 60 females (240 VAs). Comparisons between the neutral and rotated head positions were made within and between the groups.
Results: There was a significant decrease (p=0.001) in intracranial VA blood flow following cervical spine rotation, irrespective of side but greater on the contralateral side, in the total sample and in males. Females had a significantly higher blood flow than males, and although they showed a significant decrease with contralateral rotation, there was no significant difference in blood flow on the ipsilateral side.
Conclusion: Maximal rotation of the cervical spine may significantly affect vertebral artery blood flow, particularly when used in the treatment of patients with underlying vascular pathology.
Key indexing terms: Vertebral artery; blood flow; cervical spine; rotation; vertebrobasilar ischemia.
Lateral cervical curve changes in patients receiving chiropractic care following motor vehicle collision: a retrospective case series.
Roger Coleman, DC; James Hagen, DC; Stephen Troyanovich, DC; Gregory Plaugher, DC
Objective: To examine radiological changes of the lateral cervical curve in patients who received chiropractic care following motor vehicle collisions.
Design: A retrospective case series. Thirteen patients who had received chiropractic care following motor vehicle collisions were selected from a northeastern Washington chiropractic office. Each patient had a lateral cervical X-ray taken prior to the initiation of chiropractic treatment, and a comparative lateral cervical X-ray subsequent to a period of care. Cases were included if they met the previously stated criteria, and if the X-rays were of sufficient quality to determine the lateral cervical curve from C2-C7.
Results: Adjustments were rendered using an Activator adjusting instrument. Eleven of the subjects were also instructed to perform stretching exercises. Compared to the initial lateral cervical radiograph, the comparative radiographs demonstrated a mean increase in cervical lordosis between C2 and C7 of 6.4¼ (sd=8.2). The standard error estimate of the population was 2.3¼, with a 95% confidence interval of 1.4 to 11.4¼.
Conclusion: There was a mean increase in the cervical lordosis of 6.4¼ (sd=8.2). The standard error estimate of the population was 2.3¼, with a 95% confidence interval of 1.4¼ to 11.4¼. We were not able to determine the individual effects of adjustment, stretching and natural progression of the condition. The results suggest that further study of this phenomenon should be undertaken.
Key indexing terms: Chiropractic manipulation; cervical vertebrae; motor vehicle collision, radiology.
An investigation into the production of intra-articular gas bubbles and increase in joint space in the zygapophysial joints of the cervical spine following spinal manipulation in asymptomatic subjects.
Vincenzo Cascioli, (M.Tech: Chiropractic); Prof. P. Corr. MBChB, FFRad (SA) FRCR, M.Med (UCT); A.G. Till, DC, DHom. FCCS(C)
Objectives: To analyze the size and density of cervical zygapophysial joint spaces in asymptomatic subjects using computed tomography and plain film X-ray. The joint spaces were analyzed before manipulation without traction; before manipulation with manual traction; after manipulation without traction; and after manipulation with manual traction. The data obtained before the manipulation were compared with that obtained after the manipulation, to determine if significant alterations occurred.
Design: Twenty-two asymptomatic subjects were placed into one or more of six possible experimental groups. In all experimental groups, except for those comprising experiment 1, the subjects underwent: (step 1) a pre-manipulation X-ray and/or CT scan; (step 2) a pre-manipulation-plus-traction X-ray and/or CT scan; (step 3) a postmanipulation X-ray and/or CT scan; and (step 4) a postmanipulation-plus-traction X-ray and/or CT scan.
Results: Except for experiment 2, there was no significant change in the width, area and density values of the zygapophysial joint spaces immediately after the manipulation, in either the traction or traction-free positions of the neck, and no visible radiolucent cavities were demonstrated in any view.
Conclusion: No evidence of gas in the joint space or obvious increase in zygapophysial joint space width immediately after the manipulation was found. This was evident in both the traction and traction-free postmanipulation scans and plain film images. This is not consistent with the current understanding of cavitation in joints, in particular, the refractory period.
Key indexing terms: Chiropractic manipulation, cervical vertebrae; zygapophysial joint; traction; joint; X-ray; CT.
Manual discrimination capability when only viscosity is varied in viscoelastic stiffness stimuli.
Leslie Nicholson, PhD; Roger Adams, PhD; Christopher Maher, PhD
Background: Training manual therapists in the judgement of spinal stiffness traditionally requires the spines of human volunteers. Presenting the range of stiffness values representative of spines requires both time and resources. When investigating the ability of therapists to judge spinal stiffness, several studies have therefore utilized spine-analogues, nonbiological devices designed to present either purely elastic stimuli, or viscoelastic stimuli with unknown relative contributions of elastic and viscous components. Previous research has suggested that the viscous component of stiffness is more difficult to judge.
Objective: This study determined for each subject the just-noticeable difference, or discrimination threshold, for manual judgements of viscous stiffness in a constant elastic stiffness background.
Design: This psychophysical study utilized the Weber fraction as a measure of the ability of subjects to discriminate between viscoelastic stiffness stimuli.
Methods: Twenty-five subjects, with both physiotherapy and lay backgrounds volunteered to participate in the study. Stiffness stimuli were generated by a device incorporating a fluid-filled plunger and a spring, with only the amount of viscous stiffness being manipulated by the experimenter. The method of constant stimuli was used to estimate the just-discriminable change in viscous stiffness, and results were expressed as a percentage of the base stiffness, or Weber fraction.
Results: The mean Weber fraction for manual judgements of viscous stiffness was 14.7%. For 13 of the subjects who had previously participated in elastic stiffness discrimination studies, the Weber fraction for viscous stimuli was significantly greater than that for elastic stimuli.
Conclusion: The significantly higher Weber fraction for viscous stiffness perception compared with that for pure elastic stiffness suggests that the poor reliability of manual judgements of spinal stiffness may be due to the difficulty in judging the viscous stiffness component.
Key indexing terms: Stiffness; viscosity; discrimination.
Spinal palpation: the challenges of information retrieval using available databases.
Linda Murphy, MLIS; Sibylle Reinsch, PhD; Wadie Najm, MD; Vivian Dickerson, MD; Michael Seffinger, DO; Alan Adams, DC; Shiraz Mishra, MD, PhD
Purpose: This study addressed two questions: What is the yield of PubMed MEDLINE for CAM studies compared to other databases? and what is an effective search strategy to answer a sample research question on spinal palpation?
Methods: We formulated the following research question: "What is the reliability of spinal palpation procedures?" We identified specific medical subject headings (MeSH) and key terms as used in osteopathic medicine, allopathic medicine, chiropractic, and physical therapy. Using PubMed, we formulated an initial search template and applied it to 12 additional selected databases. Subsequently, we applied the inclusion criteria and evaluated the yield in terms of precision and sensitivity in identifying relevant studies.
Results: The online search result of the 13 databases identified 1,189 citations potentially addressing the research question. After excluding overlapping and nonpertinent citations, and those not meeting the inclusion criteria, 49 citations remained. PubMed yielded 19 while MANTIS, a manual therapy database, yielded 35 citations. Twenty-six of the 49 online citations were repeatedly indexed in three or more databases. Content experts and selective manual searches identified 11 additional studies. In all, we identified 60 studies that addressed the research question. The cost of the databases used for conducting this search ranged from free-of-charge to $43,000 per year for a single network subscription.
Conclusions: Commonly used databases often do not provide accurate indexing or coverage of CAM publications. Subject-specific specialized databases are recommended. Access, cost and ease of using specialized databases are limiting factors.
Key indexing terms: Complementary therapies; palpation; manual exam; spine; reliability; interexaminer; intraexaminer; information storage and retrieval.
Dietary diversity: a case study of fruit and vegetable consumption by chiropractic patients.
Jennifer Jamison, MBBCH, PhD, EdD
Background: A distinct health advantage has been linked to eating a wide variety of fresh fruit and vegetables.
Objective: This study explores the diversity of fruits and vegetables consumed by chiropractic patients and inquires into their preferred purchasing patterns.
Method: A case study that included patients attending 24 chiropractic practices in five states and the ACT was undertaken. Seven hundred eighty-two patients were asked to complete a questionnaire providing general information about their lifestyle and particular information about the number of servings of fruits and vegetables they usually consumed.
Results: Although overall chiropractic patients reported adhering to a number of healthy lifestyle behaviors, participants in this study would benefit from eating a greater diversity of fruits and vegetables.
Conclusion: In view of the substantial health benefits associated with eating a wide variety of fruits and vegetables, it is suggested that chiropractic patients be encouraged to follow a color- code system for purchasing their fresh produce.
Key indexing terms: Chiropractic; diet; fruits; vegetables.
Chiropractic Care of a Pediatric Patient with Myasthenia Gravis.
Joel Alcantara, DC; Gregory Plaugher, DC; H. Jason Araghi, DC
Objective: To describe the chiropractic care of a pediatric patient with complaints associated with myasthenia gravis.
Clinical features: A 2-year-old girl was provided chiropractic care at the request and consent of her parents for complaints of ptosis and generalized muscle weakness (i.e., lethargy), particularly in the lower extremities. Prior to entry to chiropractic management, magnetic resonance imaging of the brain and acetylcholine receptor antibody tests were performed with negative results. However, the Tensilon test was positive, and the diagnosis of myasthenia gravis was made by a pediatrician and seconded by a medical neurologist.
Intervention and outcome: The patient was cared for with contact-specific, high-velocity, low- amplitude adjustments to sites of vertebral subluxation complexes in the upper cervical and sacral spine. The patient's response to care was positive, and after five months of regular chiropractic treatment her symptoms abated completely.
Conclusion: There are indications that patients suffering from disorders "beyond low back pain," as presented in this case report, may derive benefits from chiropractic intervention/management.
Key indexing terms: Myasthenia gravis; chiropractic manipulation.
Vectored upper cervical manipulation for chronic sleep bruxism, headache and cervical spine pain in a child.
Gary Knutson, DC
Objective: To discuss the management of chronic sleep bruxism in a 6-year-old girl.
Clinical features: The patient had morning headaches and cervical spine pain. Due to abnormal tooth wear, bruxism had been previously diagnosed and was verified by observation during sleep. She also had abnormal postural and palpatory findings indicating upper cervical joint dysfunction.
Intervention and outcome: Bilateral rotary cervical stretching/mobilization and a vectored high-velocity, low-amplitude adjustment were performed in the upper cervical spine using the atlas transverse process as the contact point. There was a complete relief of the chronic subjective symptoms concomitant with remission of the objective signs of joint dysfunction.
Conclusions: Cervical (particularly upper cervical) spine muscle-joint dysfunction should be considered as a potential etiology in chronic childhood sleep bruxism.
Key indexing terms: Bruxism; pediatrics; chiropractic; cervical vertebrae; trigeminal nerve.
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