Index to Chiropractic Literature
Index to Chiropractic Literature
My ICL     Sign In
Sunday, July 21, 2019
Index to Chiropractic LiteratureIndex to Chiropractic LiteratureIndex to Chiropractic Literature
Share:

ICL Home


For best results switch to Advanced Search.
Article Detail
Return to Search Results
ID 15815
Title Uneventful upper cervical manipulation in the presence of a damaged vertebral artery [case report]
URL http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12214189
Journal J Manipulative Physiol Ther. 2002 Sep;25(7):472-483
Author(s)
Subject(s)
Peer Review Yes
Publication Type Case Report
Abstract/Notes OBJECTIVE: To discuss a case in which a patient with a previously injured vertebral artery underwent manipulation in the upper cervical spine without alteration of her symptom pattern. The literature concerning the relative safety of specific upper cervical manipulative techniques is reviewed.

CLINICAL FEATURES: A 42-year-old woman had a 3-week history of unilateral suboccipital pain that she related to a sudden twisting of her head and neck that occurred while she was putting sheets of drywall on top of her car. Subsequent examination by a neurologist 2 weeks later was unremarkable, and a tension-type headache was diagnosed. Approximately 10 days later (3 weeks after injury), a single high-velocity upper-cervical manipulation (incorporating slight rotation and full lateral flexion) was performed with no change in her symptom pattern. Two weeks after that, the patient had development of a lateral medullary syndrome (also known as Wallenberg syndrome) after she briefly extended and rotated her upper cervical spine while painting a ceiling.

INTERVENTION AND OUTCOME: The patient was treated with anticoagulant therapy, and the lateral medullary infarct healed without incident. The spinocerebellar and subtle motor symptoms also resolved, but the ipsilateral suboccipital headache and the loss of temperature sensation associated with the spinothalamic tract lesion were still present 9 months later.

CONCLUSION: This case report demonstrates that vigorous manipulation of the upper cervical spine is possible without injuring an already damaged vertebral artery. It is suggested that the line of drive used during the single manipulation, almost pure lateral flexion with slight rotation, was responsible for the apparent innocuous response. Guidelines for the evaluation and management of vertebral artery dissection are reviewed. Because it is currently impossible to identify patients at risk of having a dissected vertebral artery with standard in-office examination procedures, rotational manipulation of the upper cervical spine should be abandoned by all practitioners, and schools should remove such techniques from their curriculums.

Click on the above link for the PubMed record for this article; full text by subscription.

      Text (Citation) Tagged (Export) Excel
 
Email To
Subject
 Message
Format
HTML Text     Excel



Search Tips
  • Enclose phrases in "quotation marks".  Examples: "low back pain", "evidence-based"
  • Retrieve all forms of a word with an asterisk*, also called a wildcard or truncation.  Example: chiropract* retrieves chiropractic, chiropractor, chiropractors
  • Register an account in My ICL to save search histories (My Searches) and collections of records (My Collections)
Advanced Search Tips