Kocabey Burcu, Karagözoğlu Coşkunsu Dilber, Güven Koray, Ağaoğlu Mustafa H, Yüce Selvi
Bahcesehir University Institute of Health Sciences, Istanbul, Turkey.
Department of Physiotherapy and Rehabilitation, Fenerbahçe University Faculty of Health Sciences, Istanbul, Turkey.
J Chiropr Med. 2023 Mar;22(1):1-10. doi: 10.1016/j.jcm.2022.05.006. Epub 2022 Jul 21.
The aim of this study was to compare the hemodynamic effects of manual spinal manipulation (MSM) and instrumental spinal manipulation (ISM) on the vertebral artery (VA) and internal carotid artery (ICA) in participants with chronic nonspecific neck pain (NNP).
Thirty volunteers aged 20 to 40 years old with NNP over 3 months duration were included. Participants were randomly divided into the following 2 groups: (1) MSM group (n = 15) and (2) ISM group (n = 15). Ipsilateral (intervention side) and contralateral (opposite side of intervention) VAs and ICAs were evaluated using spectral color Doppler ultrasound before and immediately after manipulation. Measurements were recorded by visualizing the ICA carotid sinus (C4 level) and the VA at the V3 segment (C1-C2 level). The blood flow parameters of peak systolic velocity (PSV), end-diastolic velocity, resistive index, and volume flow (only for VA) were evaluated. The spinal segment, in which biomechanical aberrant movement was detected by palpation in the upper cervical spine, was manually manipulated in the MSM group. The same methodology was performed for the ISM group using an Activator V instrument (Activator Methods).
Intragroup analysis exhibited no statistically significant difference between the MSM and ISM groups in terms of PSV, end-diastolic velocity, resistive index of ipsilateral and contralateral ICA and VA, in addition to volume flow of both VAs preintervention and postintervention ( > .05). Within the intergroup analysis, there was a significant difference in ipsilateral ICA PSV ( = .031) (preintervention vs postintervention difference was -7.9 ± 17.2 cm/s [95% confidence interval, -17.4 to 1.6] in the ISM group and 8.7 ± 22.5 cm/s [95% confidence interval, -3.6 to 21.2]) in the MSM group ( < .05). Other parameters did not show any significant difference ( > .05).
Manual and instrumental spinal manipulations applied to the upper cervical spine in participants with chronic NNP did not appear to alter blood flow parameters of the VAs and ICAs.
本研究旨在比较手法脊柱推拿（MSM）和器械脊柱推拿（ISM）对慢性非特异性颈部疼痛（NNP）参与者椎动脉（VA）和颈内动脉（ICA）的血流动力学影响。
纳入30名年龄在20至40岁之间、患有持续超过3个月NNP的志愿者。参与者被随机分为以下两组：（1）MSM组（n = 15）和（2）ISM组（n = 15）。在推拿前和推拿后立即使用频谱彩色多普勒超声评估同侧（干预侧）和对侧（干预对侧）的VA和ICA。通过可视化颈内动脉的颈动脉窦（C4水平）和V3段（C1 - C2水平）的VA来记录测量值。评估收缩期峰值速度（PSV）、舒张末期速度、阻力指数和血流量（仅针对VA）等血流参数。在MSM组中，对通过触诊在上颈椎检测到生物力学异常运动的脊柱节段进行手法推拿。ISM组使用激活器V仪器（激活器方法）采用相同的方法。
组内分析显示，MSM组和ISM组在PSV、舒张末期速度、同侧和对侧ICA及VA的阻力指数以及干预前后双侧VA的血流量方面，差异均无统计学意义（P > 0.05）。在组间分析中，同侧ICA的PSV存在显著差异（P = 0.031）（ISM组干预前与干预后的差异为 -7.9 ± 17.2 cm/s [95%置信区间，-17.4至1.6]，MSM组为8.7 ± 22.5 cm/s [95%置信区间，-3.6至21.2]）（P < 0.05）。其他参数未显示任何显著差异（P > 0.05）。
对慢性NNP参与者的上颈椎进行手法和器械脊柱推拿似乎并未改变VA和ICA的血流参数。
