Effects of Head and Neck Positions on Blood Flow in the Vertebral, Internal Carotid, and Intracranial Arteries: A Systematic Review.

STUDY DESIGN Systematic review. BACKGROUND Manual therapy interventions targeting the neck comprise various positions and movements of the cranio-cervical region. The hemodynamic changes in various spinal positions potentially have clinical relevance. OBJECTIVES To investigate the effects of cranio-cervical positions and movements on hemodynamic parameters (blood flow velocity and/or volume) of cervical and cranio-cervical arteries. METHODS Four databases were searched (Pubmed, Embase, CINAHL and ICL). Subsequently, a hand search of reference lists was performed and experts were consulted. Full text experimental and quasi-experimental studies on influence of cervical positions to blood-flow of the vertebral, the internal carotid and the basilar artery were eligible for this review. Two independent reviewers selected and extracted the data using the double screening method. RESULTS Of the 1453 identified studies 31 studies were included and comprised data on 2254 participants. Most studies mentioned no significant hemodynamic changes during maximal rotation (n=16). A significant decrease in hemodynamics was identified for the vertebral artery with a hemodynamic decrease in the position of maximum rotation (n=8) and combined movement of maximum extension and maximum rotation (n=4). A similar pattern of decreased hemodynamics was also identified for the internal carotid and intracranial arteries. Three studies focused on high velocity thrust positioning and movement, all reported no hemodynamic changes. The synthesized data suggest that in the majority of people most positions and movements of the cranio-cervical region do not have an effect on blood flow. CONCLUSIONS The findings of this systematic review suggest that cranio-cervical positioning may not alter blood flow as much as previously expected. LEVEL OF EVIDENCE 2a. J Orthop Sports Phys Ther, Epub 5 Jul 2019. doi:10.2519/jospt.2019.8578.

[1]  M. Mansournia,et al.  Was it a good idea to combine the studies? Why clinicians should care about heterogeneity when making decisions based on systematic reviews , 2018, British Journal of Sports Medicine.

[2]  Çağrı Erdim,et al.  Relationship between vertebral artery blood flow in different head positions and vertigo , 2018, Acta oto-laryngologica.

[3]  D. Creighton,et al.  The application of a pre-positioned upper cervical traction mobilization to patients with painful active cervical rotation impairment: A case series. , 2017, Journal of back and musculoskeletal rehabilitation.

[4]  M. Chappell,et al.  Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease , 2017, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[5]  P. Niewiadomski,et al.  Diagnostic evaluation of neck torsion test in objective examination in patients with vertigo and/or hearing-impairment. , 2017, Otolaryngologia polska = The Polish otolaryngology.

[6]  M. Henriksen,et al.  The risk associated with spinal manipulation: an overview of reviews , 2017, Systematic Reviews.

[7]  Sanjeev Kumar,et al.  Assessment of cranial blood flow in cervical spondylosis patients , 2016 .

[8]  A. Saracoglu,et al.  Effects of Head Position on Cerebral Oxygenation and Blood Flow Velocity During Thyroidectomy. , 2016, Turkish journal of anaesthesiology and reanimation.

[9]  James Thomas,et al.  Use of cost-effectiveness analysis to compare the efficiency of study identification methods in systematic reviews , 2016, Systematic Reviews.

[10]  L. Thomas.  Cervical arterial dissection: An overview and implications for manipulative therapy practice. , 2016, Manual therapy.

[11]  R. Harbaugh,et al.  Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation , 2016, Cureus.

[12]  D. Powell,et al.  The immediate effect of atlanto-axial high velocity thrust techniques on blood flow in the vertebral artery: A randomized controlled trial. , 2015, Manual therapy.

[13]  D. Leys,et al.  Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection , 2015, The Lancet Neurology.

[14]  D. Rivett,et al.  The effect of end-range cervical rotation on vertebral and internal carotid arterial blood flow and cerebral inflow: A sub analysis of an MRI study. , 2015, Manual therapy.

[15]  Mark Petticrew,et al.  How do systematic reviews incorporate risk of bias assessments into the synthesis of evidence? A methodological study , 2014, Journal of Epidemiology & Community Health.

[16]  R. Sacco,et al.  Cervical Arterial Dissections and Association With Cervical Manipulative Therapy: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association , 2014, Stroke.

[17]  A. Rushton,et al.  International framework for examination of the cervical region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy intervention. , 2014, Manual therapy.

[18]  S. Debette.  Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts? , 2014, Current opinion in neurology.

[19]  A. Verhagen,et al.  Diagnostic Accuracy of Upper Cervical Spine Instability Tests: A Systematic Review , 2013, Physical Therapy.

[20]  C. Levi,et al.  Effect of Selected Manual Therapy Interventions for Mechanical Neck Pain on Vertebral and Internal Carotid Arterial Blood Flow and Cerebral Inflow , 2013, Physical Therapy.

[21]  A. Verhagen,et al.  Diagnostic accuracy of premanipulative vertebrobasilar insufficiency tests: a systematic review. , 2013, Manual therapy.

[22]  B. Wand,et al.  Should we abandon cervical spine manipulation for mechanical neck pain? Yes , 2012, BMJ : British Medical Journal.

[23]  D. Shamley,et al.  The effect of a simulated manipulation position on internal carotid and vertebral artery blood flow in healthy individuals. , 2011, Manual therapy.

[24]  J. Grimshaw,et al.  AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. , 2009, Journal of clinical epidemiology.

[25]  D. Leys,et al.  Cervical-artery dissections: predisposing factors, diagnosis, and outcome , 2009, The Lancet Neurology.

[26]  A. Naylor,et al.  Extracranial and transcranial ultrasound assessment in patients with suspected positional 'vertebrobasilar ischaemia'. , 2009, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[27]  Jeanette. Mitchell.  Vertebral Artery Blood flow Velocity Changes Associated with Cervical Spine rotation: A Meta-Analysis of the Evidence with implications for Professional Practice , 2009, The Journal of manual & manipulative therapy.

[28]  D. Altman,et al.  Assessing Risk of Bias in Included Studies , 2008 .

[29]  Jeanette. Mitchell,et al.  Cervical arterial dysfunction and manual therapy: a critical literature review to inform professional practice. , 2008, Manual therapy.

[30]  P. Côté,et al.  Mild Mechanical Traumas Are Possible Risk Factors for Cervical Artery Dissection , 2007, Cerebrovascular Diseases.

[31]  H. Ozdemir,et al.  Effects of Cervical Rotation on Hemodynamics in Vertebral Arteries , 2005 .

[32]  Jeanette. Mitchell,et al.  Is cervical spine rotation, as used in the standard vertebrobasilar insufficiency test, associated with a measureable change in intracranial vertebral artery blood flow? , 2004, Manual therapy.

[33]  C. Arnold,et al.  Doppler studies evaluating the effect of a physical therapy screening protocol on vertebral artery blood flow. , 2004, Manual therapy.

[34]  M. Hori,et al.  Mechanical compression of the extracranial vertebral artery during neck rotation , 2003, Neurology.

[35]  Jeanette. Mitchell.  Changes in vertebral artery blood flow following normal rotation of the cervical spine. , 2003, Journal of manipulative and physiological therapeutics.

[36]  B. Dansie,et al.  The effect of cervical rotation on blood flow in the contralateral vertebral artery. , 2003, Manual therapy.

[37]  P. Licht,et al.  Carotid artery blood flow during premanipulative testing. , 2002, Journal of manipulative and physiological therapeutics.

[38]  Frank L Mastaglia,et al.  Vertebral arteries and cervical rotation: modeling and magnetic resonance angiography studies. , 2002, Journal of manipulative and physiological therapeutics.

[39]  M. Haynes,et al.  Color duplex sonographic findings in human vertebral arteries during cervical rotation , 2001, Journal of clinical ultrasound : JCU.

[40]  P. Høilund-Carlsen,et al.  Is there a role for premanipulative testing before cervical manipulation? , 2000, Journal of manipulative and physiological therapeutics.

[41]  P. Licht,et al.  Vertebral artery volume flow in human beings. , 1999, Journal of manipulative and physiological therapeutics.

[42]  D. Rivett,et al.  Effect of premanipulative tests on vertebral artery and internal carotid artery blood flow: a pilot study. , 1999, Journal of manipulative and physiological therapeutics.

[43]  Zhang B,et al.  Changes and implications of blood flow velocity of the vertebral artery during rotation and extension of the head. , 1999, Journal of Manipulative and Physiological Therapeutics.

[44]  M. L. Walker,et al.  Basilar artery blood flow during head rotation in vertebrobasilar ischemia , 1996, Acta neurologica Scandinavica.

[45]  M. Weintraub,et al.  Critical Neck Position as an Independent Risk Factor for Posterior Circulation Stroke , 1995, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[46]  D. Newell,et al.  Dynamic Transcranial Doppler Assessment of Positional Vertebrobasilar Ischemia , 1994, Stroke.

[47]  K. Yong-Hing,et al.  Effect of various head and neck positions on vertebral artery blood flow. , 1994, Clinical biomechanics.

[48]  P. Hedera,et al.  Blood flow velocities in basilar artery during rotation of the head , 1993, Acta neurologica Scandinavica.

[49]  小島原典子,et al.  診断精度研究のバイアスリスク評価ツールQUADAS－2：a Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies 2 の活用 , 2014 .

[50]  Jairus J. Quesnele,et al.  Changes in vertebral artery blood flow following various head positions and cervical spine manipulation. , 2014, Journal of manipulative and physiological therapeutics.

[51]  T. Perl.  Glossary of terms. , 2009, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[52]  D. Rivett,et al.  Reliability of ultrasonographic measurement of vertebral artery blood flow , 2003 .

[53]  L. G. Giles.  The validity of the extension-rotation test as a clinical screening procedure before neck manipulation: a secondary analysis. , 1997, Journal of manipulative and physiological therapeutics.

[54]  De Kleyn,et al.  Schwindelanfalle und Nystagmus bei einer bestimmten Stellung des Kopfes , 1927 .