Should we be using pre-treatment positional testing of the cervical spine to screen for vertebrobasilar insufficiency?
- RRS Education
This week, our Research Review covers an important topic we discuss in detail in our new E-Seminar “Chiropractic Checkup from the Neck Up”, which features my talk called “The ‘Dissection Connection’: Is this patient having a stroke? (check it out HERE)
Vertebrobasilar insufficiency (VBI) is an infrequent condition encountered by chiropractors and manual therapists in all disciplines, however, one must always be alert to the fact that these patients can walk into our offices. An approach that is used by some clinicians to help rule in or rule out a potential VBI includes cervical positional testing, which is thought to assess and determine the patient’s risk profile prior to performing cervical, high-velocity manipulation. This approach is also still being taught in some institutions, despite a lack of evidence directly establishing causality between SMT and cervical stroke. Further, the utility of these tests is unclear, resulting in some individuals calling for these tests to be altogether abandoned in clinical practice.
The proposed VBI screening tests typically consist of combined cervical extension and rotation and sustained end-range rotation. The pre-manipulative position has also been proposed as an alternative VBI test. Theoretically, these tests examine the mechanical stresses on the vertebral arteries during cervical spine movements by causing a narrowing of the vessel lumen. It is thought the contralateral side of head rotation is compromised, and when collateral circulation is unable to compensate for the decreased blood flow, symptoms of VBI would be seen through reduced brainstem perfusion.
In this paper, the authors argue that – from professional and research perspectives – the use of VBI tests cannot be recommended: LOG IN OR SUBSCRIBE TO ACCESS THIS REVIEW
THIS WEEK'S RESEARCH REVIEW: “Pre-Treatment Positional Testing of the Cervical Spine to Screen for Vertebrobasilar Insufficiency”
This paper was published in Musculoskeletal Science & Practice (2020) and this Review is posted in Recent Reviews, Clinical Testing & Procedures, Spinal Manipulation - Adverse Events & Safety and the 2020 Archive.