Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands.
Research Group on Healthy Aging, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands.
Musculoskelet Sci Pract. 2020 Oct;49:102181. doi: 10.1016/j.msksp.2020.102181. Epub 2020 Jun 20.
Although there seems to be no causality between cervical spine (CS) manipulation and major adverse events (MAE), it remains important that manual therapists try to prevent every potential MAE. Although the validity of positional testing for vertebrobasilar insufficiency (VBI) has been questioned, recently, the use of these tests was recommended. However, based on the low sensitivity of the VBI tests, which may result in too many false-negative results, the VBI tests seem to be less valuable in pre-manipulative screening. Moreover, because the VBI tests are unable to consistently produce a decreased blood flow in the contralateral vertebral artery in (healthy people), the underlying mechanism of the test may not be a valid construct. There are numerous cases reporting MAE after a negative VBI test, indicating that the VBI tests do not have a role in assessing the risk of serious neurovascular pathology, such as cervical arterial dissection, the most frequently described MAE after CS manipulation. Symptoms of VBI can be identified in the patient interview and should be considered as red flags or warning signs and require further medical investigation. VBI tests are not able to predict MAE and seem not to have any added value to the patient interview with regard to detecting VBI or another vascular pathology. Furthermore, a negative VBI test can be wrongly interpreted as 'safe to manipulate'. Therefore, the use of VBI tests cannot be recommended and should be abandoned.
虽然颈椎（CS）手法与主要不良事件（MAE）之间似乎没有因果关系，但手法治疗师仍应尽力预防每一个潜在的 MAE。虽然位置性测试对椎基底动脉供血不足（VBI）的有效性存在争议，但最近这些测试被推荐使用。然而，由于 VBI 测试的敏感性较低，可能导致过多的假阴性结果，因此这些测试在手法治疗前的筛查中似乎价值不大。此外，由于 VBI 测试不能在（健康人群中）始终产生对侧椎动脉血流减少，因此该测试的潜在机制可能不是一个有效的结构。有许多报道称在 VBI 测试阴性后发生 MAE 的案例，这表明 VBI 测试在评估严重神经血管病理学风险方面没有作用，例如颈椎动脉夹层，这是 CS 手法后最常描述的 MAE。VBI 的症状可以在患者访谈中识别出来，并应被视为红色信号或警告信号，需要进一步的医学调查。VBI 测试不能预测 MAE，并且在检测 VBI 或其他血管病理学方面，似乎与患者访谈没有任何附加价值。此外，VBI 测试阴性可能会被错误地解释为“可以安全操作”。因此，不能推荐使用 VBI 测试，而应予以摒弃。
