Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial

• Published in: BMJ open 2019-05, Vol.9 (5), p.e025219-e025219
• Main Authors: Moser, Nicholas, Mior, Silvano, Noseworthy, Michael, Côté, Pierre, Wells, Greg, Behr, Michael, Triano, John
• Format: Article
• Language: English
• Subjects: Adult; Anticoagulants; Arterial Occlusive Diseases - epidemiology; Arterial Occlusive Diseases - etiology; Arterial Occlusive Diseases - physiopathology; Chronic Pain - epidemiology; Chronic Pain - physiopathology; Chronic Pain - therapy; Complementary Medicine; Cross-Over Studies; Dissection; Evidence-based medicine; Female; Hemodynamics; Humans; Hypotheses; Male; Manipulation, Spinal - adverse effects; Manipulation, Spinal - statistics & numerical data; Neck pain; Neck Pain - epidemiology; Neck Pain - physiopathology; Neck Pain - therapy; NMR; Nuclear magnetic resonance; Ontario - epidemiology; Range of Motion, Articular - physiology; Regional Blood Flow; Risk Assessment; Spinal manipulation; Spine; Stroke; Ultrasonic imaging; Veins & arteries; Vertebrobasilar Insufficiency - epidemiology; Vertebrobasilar Insufficiency - etiology; Vertebrobasilar Insufficiency - physiopathology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2018-025219

ObjectiveIt is hypothesised that cervical manipulation may increase the risk of cerebrovascular accidents. We aimed to determine whether cervical spine manipulation is associated with changes in vertebral artery and cerebrovascular haemodynamics measured with MRI compared with neutral neck position and maximum neck rotation in patients with chronic neck pain.SettingThe Imaging Research Centre at St. Joseph’s Hospital in Hamilton, Ontario, Canada.ParticipantsTwenty patients were included. The mean age was 32 years (SD ±12.5), mean neck pain duration was 5.3 years (SD ±5.7) and mean neck disability index score was 13/50 (SD ±6.4).InterventionsFollowing baseline measurement of cerebrovascular haemodynamics, we randomised participants to: (1) maximal neck rotation followed by cervical manipulation or (2) cervical manipulation followed by maximal neck rotation. The primary outcome, vertebral arteries and cerebral haemodynamics, was measured after each intervention and was obtained by measuring three-dimensional T1-weighted high-resolution anatomical images, arterial spin labelling and phase-contrast flow encoded MRI. Our secondary outcome was functional connectivity within the default mode network measured with resting state functional MRI.ResultsCompared with neutral neck position, we found a significant change in contralateral blood flow following maximal neck rotation. There was also a significant change in contralateral vertebral artery blood velocity following maximal neck rotation and cervical manipulation. We found no significant changes within the cerebral haemodynamics following cervical manipulation or maximal neck rotation. However, we observed significant increases in functional connectivity in the posterior cerebrum and cerebellum (resting state MRI) after manipulation and maximum rotation.ConclusionOur results are in accordance with previous work, which has shown a decrease in blood flow and velocity in the contralateral vertebral artery with head rotation. This may explain why we also observed a decrease in blood velocity with manipulation because it involves neck rotation. Our work is the first to show that cervical manipulation does not result in brain perfusion changes compared with a neutral neck position or maximal neck rotation. The changes observed were found to not be clinically meaningful and suggests that cervical manipulation may not increase the risk of cerebrovascular events through a haemodynamic mechanism.Trial registration number