Sept. 1995 Sept. 1995
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Each quarter, Chiropractic OnLine Today will present the Table of Contents and current Abstracts from Aspen Publications' Topics in Clinical Chiropractic.
The following list comprises TICC's Editorial advisory board:
Robert D. Mootz, DC, DABCO, FICC
Linda J. Bowers, DC, DABCO, DABCI, DACBN, DACAN
Daniel T. Hansen, DC, DABCO, FICC
Kevin A. McCarthy, DC, DABCO
Howard Vernon, DC, FCCS
Dorrie M. Talmage, DC, DABCO
Alan H. Adams, DC
Bernard A. Coyle, PhD
Phillip S. Ebrall, BAppSC (Chiropractic)
Gary Greenstein, DC
Warren I. Hammer, DC, MS, DABCO
Karl C. Kranz, DC
Marion McGregor, Bsc, DC, FCCS (c)
Donna M. Mannello, DC
Paul J. Osterbauer, DC, MPH
Lindsay J. Rowe, MAppSc, MD, DACBR (USA), FCCR (CAN), FACCR (AUST), FICC
Olga Rutherford, BA, Msc, PhD
Tilden H. Sokoloff, DPM, MS, DC
Thomas A. Souza, DC, CCSP
Richard D. Stonebrink, BS, DC, ND, FACO, FICC
Topics in Clinical Chiropractic welcomes original scholarly manuscripts for peer review and consideration for publication. Articles relevant to topics being addressed in upcoming issues (as outlined below) will be considered. Prospective authors should submit manuscripts directly to the issue editor for a given topic or to Robert D. Mootz, DC, Associate Medical Director for Chiropractic State of Washington Department of Labor and Industries, PO Box 44321, Olympia, WA 98504-4321. Please note deadlines for receipt or completed manuscripts for each issue below. Authors are responsible for obtaining reprint permissions and paying any fees or charges for non-original charts, figures, artwork, or appendixes. For a more detailed packet of information for authors, contact Aspen Publishers, Inc., 200 Orchard Ridge Drive, Suite 200, Gaithersburg, MD 20878.
Volume 3(3): Care of the Lumbar Spine. This issue offers a review of state-of-the-art chiropractic management of lumbar spine disorders. Manuscripts are sought dealing with assessment and conservative management strategies for the lumbar spine. Anyone interested in preparing an article for submission should contact the issue editor as early as possible. Deadline: January 15, 1996. Issue Editor: Howard Vernon, DC, Director of the Center for the Study of Spinal Health, 1396 Eglington Ave. West, Toronto, Ontario M6C 2E4, Canada.
Volume 3(4): Wellness. Strategies for chiropractic physicians providing early intervention screening will be covered in this issue. Manuscripts are sought on a variety of topics regarding disease prevention and health promotion. Topics of interest include psychological aspects of wellness, stress reduction and preventive and maintenance chiropractic care, among others. Those interested in submitting manuscripts should contact the issue editor as early as possible. Deadline: May 1, 1996. Issue Editor: Linda J. Bowers, Professor, Northwestern College of Chiropractic, 2501 W. 84th Street, Bloomington, MN 55431.
Volume 4(1): Exercise and Rehabilitation. A practical look at exercise and rehabilitation for the clinician is offered. Manuscripts detailing management strategies for incorporation of exercise and rehabilitation into chiropractic practice are sought. Office approaches, as well as referral programs, are appropriate. Deadline: August 1, 1996. Issue Editor: Robert D. Mootz, DC, Associate Medical Director for Chiropractic, State of Washington Department of Labor and Industries, P.O. Box 44321, Olympia, WA 98504-4321.
TOC
Back to Basics: Clinical considerations in the mechanical assessment of the cervical spine
The clinical usefulness of flexion-extension radiographs in the cervical spine
Atypical sensory phenomenon: How to differentiate migraine, seizure, and transient ischemic attack
Spinal manipulation and headaches: An update
Cervical spondylotic myelopathy
Vertebrobasilar compromise associated with cervical manipulation
Appendixes: Algorithms, forms, and other clinical aids related to the articles in this issue
Symptoms of neck pain and restriction are common complaints in chiropractic practice and are frequently the result of mechanical dysfunction in the joints and soft tissue of the cervical spine. Cervical symptoms may also result from mechanopathology in regions other than the cervical spine and from nonmechanical organic pathology. The potential overlap of findings and shared symptoms among different etiologies creates a challenge for the clinician in the diagnostic work-up. A thorough clinical evaluation is critical to establishing the probable cause of symptoms, identifying possible complicating factors, establishing reasonable outcome parameters, and developing a sensible clinical course of management. An approach to mechanical evaluation of the cervical spine is discussed and seed algorithms are presented to aid in the clinical work-up. Key words: cervical vertebrae; muscles; pain; neck; diagnosis; physical examination; palpation; neurologic examination; ROM, articular; biomechanics, algorithm
This prospective study evaluated effectiveness of flexion-extension radiographs in aiding chiropractic clinicians to diagnose intersegmental clinical hypermobility (ICH). Adults with neck and/or head pain were solicited. Cases were coded and randomly presented, with and without flexion-extension radiographs to three clinicians, for the evaluation of the presence and location of ICH.
Two radiology residents independently evaluated the flexion-extension radiographs via motion diagrams on two separate occasions to assess interexaminer and test-retest reliability. Generalizability coefficients indicated moderate to high agreement between the two radiology residents’ overlay measurements, except at C2 and C7, where visualization was difficult. A tendency was observed for larger flexion-extension excursions to be related to more of the clinicians indications they would avoid manipulating the segment. The data in this study reflect clinical confusion regarding the diagnosis of increased cervical intersegmental motion. The diagnosis of ICH appeared to be altered by the presentation of flexion-extension radiographs; however, the accuracy of the diagnosis remains tenuous. Quantification of motion diagrams is reasonable reliable. The excursion values for patients considered in this study most likely to have ICH were less than expected in light of previously reported work. Key words: cervical vertebrae; radiography; spine; joint instability; biomechanics; pain; neck; movement.
The differential diagnosis of migraine headache, seizure, and transient ischemic attack can be confounding. This is particularly true when altered somatic sensibility is the only apparent symptom - a complaint that is echoed frequently by patients who present to chiropractic physicians. Unlike migraine headaches, which usually favor a good prognosis, seizures and transient ischemic attacks may be the harbingers of intracranial pathology. Transient ischemic attack is an important risk factor for ischemic stroke, and seizure may be associated with an intracranial mass lesion. Prompt recognition of these disorders and referral to the appropriate specialist can result in a significant reduction in the risk of neurologic sequel. This article provides a diagnostic algorithm for an atypical sensory phenomenon and cites three case reports. Key words: migraine; seizures; cerebral ischemia, transient; diagnosis, differential; nervous system diseases; sensation; algorithm; headache; vascular headache.
The role of the cervical spine and of spinal manipulation in headache remain unresolved. This article will review the existing literature in three important areas which relate to these controversies, namely: (1) studies of spinal manipulation for headache; (2) mechanisms of cervicogenic head pain; and (3) components of cervicogenic dysfunction. The main thesis of this article is that the cervical spine plays an important role in benign headache and that evidence exists supporting chiropractic spinal manipulation as a beneficial therapy. Key words: headache; chiropractic; tension headache; neck; manipulation, orthopedic; algorithm.
Spondylotic myelopathy of the cervical spine is a clinical entity that is a consequence and a complication of degenerative spinal disease. Recognition and identification of the salient characteristic signs and symptomatology of this syndrome are of major clinical importance. Prudent evaluation and monitoring of the progression of this syndrome are of importance in clinical practice to avoid irreversible neurologic damage. Referral for surgical decompression may be necessary depending on the nature, severity, and level of involvement encountered. Key words: cervical vertebrae; spinal diseases; spinal osteophytosis; spinal cord compression; peripheral nervous system diseases; myelography; spinal cord; algorithm.
An overview of the RAND appropriateness method is provided along with a summary of key results of the recent multidisciplinary expert consensus panel assessing the appropriateness of manipulation and mobilization in the cervical spine. Appropriate use of such results is discussed. The RAND appropriateness method was used, which involved a synthesis of literature, creation of a clinical indications list based on the literature, and input from informed sources. An expert multidisciplinary panel of clinicians was selected and a Delphi rating round for appropriateness of cervical spine manipulation and mobilization was performed. Results were tabulated and the panel was convened for second round of appropriateness ratings. Over 1400 clinical scenarios (indications) were rated. The panel demonstrated clear agreement on 40% of the indications and clear disagreement on 2% of them.
Regarding the appropriateness of cervical manipulation or mobilization for the indications, 43% of the indications were rated inappropriate for the intervention with 41% ranking as uncertain and 16% considered appropriate. The level of panel disagreement was higher with manipulation compared to mobilization. The utility of the results of this appropriateness panel is discussed relative to practicing chiropractors, non-physicians, and the chiropractic profession as a whole. Key words: cervical vertebrae; chiropractic; manipulation, orthopedic; spine; neck; health services research; literature; Delphi technique; health status indicators; health surveys; consensus development conferences.
Spinal manipulation therapy has been linked with cerebrovascular accidents in both the chiropractic and medical literature. However, knowledge regarding the mechanism of injury, incidence rates, screening tests, and risk factors for such events remains incomplete and controversial. Attempts to define the population at risk have considered demographic and lifestyle factors, vascular pathology, and mechanical compression, without successfully identifying any particular factors (s) that could be used for screening. Current estimates of post-cervical manipulation cerebrovascular accidents suggest that these complications are less frequent than adverse effects associated with other commonly used interventions for treatment of neck pain. Precise knowledge regarding post-manipulation vertebrobasilar compromise will depend on further data supplied by better documented comprehensive case reports. Key words: cerebrovascular disorders; risk factors; cervical vertebrae; chiropractic; therapeutics; manipulation, orthopedic; malpractice; vertebral artery; vertebrobasilar insufficiency; basilar artery; neck.
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