Intradiscal Pressure Changes during Manual Cervical Distraction: A Cadaveric Study

M R Gudavalli,T Potluri,C Goertz,G C Joachim,R A Kruse,J M Cox,L I Voronov,R M Havey,R M Rowell,A G Patwardhan,C N R Henderson,G Carandang

doi:10.1155/2013/954134

Abstract

The objective of this study was to measure intradiscal pressure (IDP) changes in the lower cervical spine during a manual cervical distraction (MCD) procedure. Incisions were made anteriorly, and pressure transducers were inserted into each nucleus at lower cervical discs. Four skilled doctors of chiropractic (DCs) performed MCD procedure on nine specimens in prone position with contacts at C5 or at C6 vertebrae with the headpiece in different positions. IDP changes, traction forces, and manually applied posterior-to-anterior forces were analyzed using descriptive statistics. IDP decreases were observed during MCD procedure at all lower cervical levels C4-C5, C5-C6, and C6-C7. The mean IDP decreases were as high as 168.7 KPa. Mean traction forces were as high as 119.2 N. Posterior-to-anterior forces applied during manual traction were as high as 82.6 N. Intraclinician reliability for IDP decrease was high for all four DCs. While two DCs had high intraclinician reliability for applied traction force, the other two DCs demonstrated only moderate reliability. IDP decreases were greatest during moving flexion and traction. They were progressevely less pronouced with neutral traction, fixed flexion and traction, and generalized traction.

Highlights

Neck pain and neck-related shoulder and arm pain are a major health problem in Western societies [1,2,3,4,5]
The objectives of this study were; in unembalmed cadavers with intact head, neck, and trunk: (1) measure intradiscal pressure (IDP) in the lower cervical spine (C4-C5, C5-C6, C6-C7, and C7-T1) and (2) during the manual cervical distraction (MCD) procedure performed by study doctors of chiropractic (DCs), measure the magnituded and reliability of applied forces
IDP data and the force data had a different number of observations

Summary

Introduction

Neck pain and neck-related shoulder and arm pain are a major health problem in Western societies [1,2,3,4,5]. Symptoms may include pain, tingling, numbness, stiffness, loss of coordination or physical strength, skin discoloration, and temperature differences located in the neck, shoulder, arm, elbow, wrist, hand, and/or fingers. These complaints cause discomfort and may lead to severe long-term pain and physical disability creating an economic burden due to work absences and healthcare costs [1]. Between 1999 and 2008, the mean inflation-adjusted annual expenditures on medical care for these patients increased by 95% (from $487 to $950); most of the increase was accounted for by increased costs for medical specialists, as opposed to primary care physicians. Physical therapy was the most costly service overall [7]

Objectives

Methods

Results

Conclusion