Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada.
Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
BMJ Open. 2019 May 28;9(5):e025219. doi: 10.1136/bmjopen-2018-025219.
It 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.
The Imaging Research Centre at St. Joseph's Hospital in Hamilton, Ontario, Canada.
Twenty 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).
Following 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.
Compared 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.
Our 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.
NCT02667821.
据推测，颈椎推拿可能会增加中风的风险。我们旨在确定颈椎推拿是否与慢性颈痛患者的磁共振成像（MRI）测量的椎动脉和脑血管血液动力学变化有关，与中立位颈部和最大颈部旋转相比。
加拿大安大略省汉密尔顿圣约瑟夫医院的成像研究中心。
共纳入 20 名患者。平均年龄为 32 岁（标准差±12.5），平均颈部疼痛持续时间为 5.3 年（标准差±5.7），颈部残疾指数评分为 13/50（标准差±6.4）。
在脑血管血液动力学的基线测量后，我们将参与者随机分为：（1）最大颈部旋转后进行颈椎推拿，或（2）颈椎推拿后进行最大颈部旋转。主要结局指标，椎动脉和脑血液动力学，在每次干预后进行测量，并通过测量三维 T1 加权高分辨率解剖图像、动脉自旋标记和相位对比血流编码 MRI 来获得。我们的次要结局是使用静息状态功能 MRI 测量默认模式网络内的功能连接。
与中立位颈部相比，我们发现最大颈部旋转后对侧血流有显著变化。最大颈部旋转和颈椎推拿后，对侧椎动脉血流速度也有显著变化。我们发现颈椎推拿或最大颈部旋转后，脑血液动力学无显著变化。然而，我们观察到在操作和最大旋转后，后脑和小脑（静息状态 MRI）的功能连接显著增加。
我们的结果与先前的工作一致，先前的工作表明，头部旋转会导致对侧椎动脉的血流量和速度下降。这可能解释了为什么我们也观察到操作后血流速度下降，因为它涉及颈部旋转。我们的工作是第一个表明颈椎推拿与中立位颈部或最大颈部旋转相比，不会导致脑灌注变化的研究。观察到的变化没有临床意义，表明颈椎推拿可能不会通过血液动力学机制增加中风事件的风险。
NCT02667821。
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