Cervical Spine Position Research Articles

Relationship between position sense and reposition errors according to the degree of upper crossed syndrome.

[Purpose] The purpose of this study was to compare reposition errors in subjects with upper crossed syndrome to examine the effects of upper crossed syndrome on position senses. [Subjects and Methods] A sample population of 60 subjects was randomly divided into three groups of 20: a normal group, a mild group, a moderate group. A cervical range of motion device was attached to the head of each subject using straps and the reposition errors of cervical flexion, extension, right lateral flexion, left lateral flexion, right rotation and left rotation were measured. [Results] The normal group showed smaller reposition errors than the mild group and the mild group showed smaller reposition errors than the moderate group but none of the differences among the three groups was significant. [Conclusion] Reposition errors increased in the order of the normal, mild, moderate group but the differences were not significant. In addition, the degree of the subjects’ postural misalignment was higher in the moderate than in the mild group. These results demonstrate that cervical spine position sense declines as postural misalignment becomes more severe.

Effect of Cervical Corrective Exercises on Pain, Neck Posture, and Intersegmental Motion of Cervical Spine in a Patient With Cervical Radiculopathy: A Case Report

This case report describes the effectiveness of cervical corrective exercises in a patient with cervical radiculopathy (CR) who experienced radicular pain, upper limb paresis, and limited functional activity. A 39-year-old male with cervical radiculopathy performed the cervical corrective exercises for reducing pain. Pain intensity, cervical posture, and active range of motion of cervical intersegmental spine motion were measured baseline, after 4 weeks, and after 8 weeks with self-reported questionnaire and radiographs. After 8 weeks of intervention, the patient demonstrated alleviated radicular symptoms, improved neck posture and active range of flexion and extension of the cervical intersegmental spine. Especially in the angle between the cervical vertebra 6 and 7, the angle was changed from -4.69° to 3.30° during resting position after intervention. The present case indicates that the cervical corrective exercises might be a possible treatment to effectively reduce radicular symptoms, improve neck posture, and active cervical intersegmental motion for patient with CR.

Photographic measurement of head and cervical posture when viewing mobile phone: a pilot study.

With the dramatic growth of mobile phone usage, concerns have been raised with regard to the adverse health effects of mobile phone on spinal posture. The aim of this study was to determine the head and cervical postures by photogrammetry when viewing the mobile phone screen, compared with those in neutral standing posture. A total of 186 subjects (81 females and 105 males) aged from 17 to 31years old participated in this study. Subjects were instructed to stand neutrally and using mobile phone as in daily life. Using a photographic method, the sagittal head and cervical postures were assessed by head tilt angle, neck tilt angle, forward head shift and gaze angle. The photographic method showed a high intra-rater and inter-rater reliability in measuring the sagittal posture of cervical spine and gaze angle (ICCs ranged from 0.80 to 0.99). When looking at mobile phone, the head tilt angle significantly increased (from 74.55° to 95.22°, p=0.000) and the neck angle decreased (from 54.68° to 38.77°, p=0.000). The forward head posture was also confirmed by the significantly increased head shift (from 10.90 to 13.85cm, p=0.000). The posture assumed in mobile phone use was significantly correlated with neutral posture (p<0.05). Males displayed a more forward head posture than females (p<0.05). The head tilt angle was positively correlated with the gaze angle (r=0.616, p=0.000), while the neck tilt angle was negatively correlated with the gaze angle (r=-0.628, p=0.000). Photogrammetry is a reliable, quantitative method to evaluate the head and cervical posture during mobile phone use. Compared to neutral standing, subjects display a more forward head posture when viewing the mobile phone screen, which is correlated with neutral posture, gaze angle and gender. Future studies will be needed to investigate a dose-response relationship between mobile phone use and assumed posture.

Biomechanical modelling of impact-related fracture characteristics and injury patterns of the cervical spine associated with riding accidents

BackgroundHorse-related injuries are manifold and can involve the upper and lower limbs, the trunk, spine or head. Cervical spine injuries are not among the most common injuries. However, they can be fatal and often result in neurological symptoms. This study investigated the influence of the posture of the cervical spine on the ultimate strength and the pattern of vertebrae failure with the aim to provide some guidance for protective clothing design. MethodsEighteen human cervical spines, each divided into two specimens (three vertebrae each), were subjected to a simulator test designed to mimic a spinal trauma in different postures of the specimen (neutral, flexion, extension). The stress-to-failure, the deformation at the time of fracture and the fracture patterns assessed based on CT scans were analysed. FindingsStress-to-failure of the superior specimens was lower for the flexion group compared to the others (P=0.027). The superior specimens demonstrated higher stress-to-failure in comparison to the inferior specimens (P<0.001). Compression in a neutral or flexed position generated mild or moderate fracture patterns. On the contrary, the placement of the spine in extension resulted in severe fractures mostly associated with narrowing of the spinal canal. InterpretationThe results imply that a neutral cervical spine position during an impaction can be beneficial. In this position, the failure loads are high, and even if a vertebral fracture occurs, the generated injury patterns are expected to be mild or moderate.

A novel skull clamp positioning system and technique for posterior cervical surgery: clinical impact on cervical sagittal alignment.

A prospective radiographic study.The purpose of this study was to analyze whether a novel skull clamp positioning system and technique is useful for obtaining good, quantitative cervical sagittal alignment during posterior cervical surgery.Different surgical procedures depend on cervical spine positioning. However, maneuver of the device and cervical position depends on the skill of the operator.This study included 21 male and 10 female patients with cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament of the cervical spine, undergoing posterior cervical surgery using the novel skull clamp positioning system. The average patient age was 68.6 years (range: 56–87 years). The novel system has a scale to adjust the neck position and to enable intended cervical sagittal alignment. First, the patient was placed on the operating table in the prone position with preplanned head–neck sagittal alignment (neutral position in general). The head was rotated sagittally, and the head was positioned in the military tuck position with the novel device that was used to widen the interlaminar space. After completing the decompression procedure, the head was rotated again back to the initial preplanned position. During this position change, the scale equipped with the device was useful in determining accurate positions. The C0-C1, C0-C2, C1-C2, C2-C7, and C0-C7 angles were measured on lateral radiographs taken pre-, intra-, and postoperatively.This novel system allowed us to obtain adequate, quantitative cervical sagittal alignment during posterior cervical surgery. There were no clinically significant differences observed between the pre- and postoperative angles for C1-C2 and C2-C7.Sagittal neck position was quantitatively changed during posterior cervical surgery using a novel skull clamp positioning system, enabling adequate final cervical sagittal alignment identical to the preplanned neck position.

Effect of playing basketball on the posture of cervical spine in healthy collegiate students

Objective: To assess and compare the cervical posture of collegiate students and collegiate basketball players. Procedure: Craniovertebral angle and Sagittal head tilt were measured using photogrammetric method in 15 collegiate students and 15 collegiate basketball players. Results: Significant differences were not found between two groups for any of the two angles at p<0.05. Conclusions: Playing basketball does not place any significant impact on the posture of cervical spine of collegiate students. Key words: posture, basketball, craniovertebral angle, sagittal head tilt

Head and cervical spine posture in behaving rats: implications for modeling human conditions involving the head and cervical spine.

The aim of this study was to define the temporal and spatial (postural) characteristics of the head and cervical vertebral column (spine) of behaving rats in order to better understand their suitability as a model to study human conditions involving the head and neck. Time spent in each of four behavioral postures was determined from video tape recordings of rats (n = 10) in the absence and presence of an intruder rat. Plain film radiographic examination of a subset of these rats (n = 5) in each of these postures allowed measurement of head and cervical vertebral column positions adopted by the rats. When single they were quadruped or crouched most (∼80%) of the time and bipedal either supported or free standing for only ∼10% of the time. The introduction of an intruder significantly (P < 0.0001) reduced the proportion of time rats spent quadruped (median, from 71% to 47%) and bipedal free standing (median, from 2.9% to 0.4%). The cervical spine was orientated (median, 25-75 percentile) near vertical (18.8°, 4.2°-30.9°) when quadruped, crouched (15.4°, 7.6°-69.3°) and bipedal supported (10.5°, 4.8°-22.6°) but tended to be less vertical oriented when bipedal free standing (25.9°, 7.7°-39.3°). The range of head positions relative to the cervical spine was largest when crouched (73.4°) and smallest when erect free standing (17.7°). This study indicates that, like humans, rats have near vertical orientated cervical vertebral columns but, in contrast to humans, they displace their head in space by movements at both the cervico-thoracic junction and the cranio-cervical regions.

Effects of neuromuscular deprogramming on the head position

Objectives:The aim of this study was to evaluate the effects of the neuromuscular deprogramming of the mandible on the craniocervical position.Methods:Participants (n = 65) were separated into two groups: 25 untreated controls (10 men and 15 women) and 40 patients (17 men and 23 women) and underwent neuromuscular deprogramming with upper occlusal splints for an average of 6 months and 7 days, before orthodontic treatment. Lateral cephalograms were obtained from each subject in the natural head position (NHP), before and after neuromuscular deprogramming. Craniocervical cephalometric analysis was performed to evaluate craniovertical (NSL/VER), craniocervical (OPT/NSL and CVT/NSL), and cervicohorizontal (OPT/HOR and CVT/HOR) angulation, and the angle of the cervical curvature (OPT/CVT).Results:After neuromuscular deprogramming, significant changes in three angles — NSL/VER (P<0·001), OPT/NSL (P<0·001) and CVT/NSL (P<0·001) — were found between the two groups. For the cervical spine position, no significant changes were observed.Conclusion:The results indicate that neuromuscular deprogramming using occlusal splint causes significant extension of the head.

Therapeutic effects of functional orthodontic appliances on cervical spine posture: a retrospective cephalometric study

IntroductionInteractions between the cervical spine and the stomatognathic system have been discussed in literature. The present study was conducted to investigate whether, and to what extent, orthodontically induced mandibular advancement produces changes in cervical spine posture. Furthermore, possible appliance-specific effects should be distinguished.Material and methodsThe cephalograms of 64 patients with skeletal class II were analysed before and after mandibular advancement. Linear and angular cephalometric parameters were identified to define the position of the atlanto-occipital and atlantoaxial joints. The total example was divided into two subgroups (comprising 32 individuals each) according to the employed appliance: activator versus bite-jump appliance (BJA). Student's t-test and analysis of covariance were used for statistical analysis.ResultsOverall, a significant straightening of the cervical spine was observed during the treatment. This conclusion is based on changes of Chamberlain (p = 0.0055), CVT (p = 0.0003), OPT (p < 0.0001), Redlund-Johnell/Petersson (p < 0.0001), McGregor-mC2 (p = 0.0333) and AT-FH (p = 0.0445). Improvements in occipitoatlantal dislocation were also observed in the total sample. Appliance-specific changes were found in the activator subgroup for a number of linear parameters (Chamberlain, McGregor, CVT, OPT, Redlund-Johnell/Petersson). In contrast, only two linear parameters (OPT and Powers ratio) revealed statistically significant changes in the BJA subgroup.ConclusionsDuring skeletal class II treatment the position of upper cervical spine changes. In the activator subgroup the observed effects were more pronounced than those in the BJA subgroup. Further studies including a control group comprised with non-treated class II patients are needed to assess whether these effects may be caused directly by the appliances irrespective of growth.

Changes in Vertebral Artery Blood Flow Following Various Head Positions and Cervical Spine Manipulation

ObjectiveThe objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery (VA). MethodsThis pilot study was conducted as a blinded examiner cohort with 4 randomized clinical tasks. Ten healthy male participants aged 24 to 30 years (mean, 26.8 years) volunteered to participate in the study. None of the participants had a history of disabling neck, arm, or headache pain within the last 6 months. They did not have any current or history of neurologic symptoms. In a neutral head position, physiologic measures of VA blood flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic resonance imaging after 3 different head positions and a chiropractic upper cervical spinal manipulation. A total of 30 flow-encoded phase-contrast images were collected over the cardiac cycle, in each of the 4 conditions, and were used to provide a blood flow profile for one complete cardiac cycle. Differences between flow (in milliliters per second) and velocity (in centimeters per second) variables were evaluated using repeated-measures analysis of variance. ResultsThe side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities (P = .14) or flows (P = .19) throughout the conditions. There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables. ConclusionsThere were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations.

The influence of cervical spine position on the three anterior endoscopic approaches to the craniovertebral junction: an imaging study

Background contextThree endoscopic anterior approaches, the transnasal, transoral, and transcervical approaches, are used for ventral lesions of the craniovertebral junction and have been compared regarding surgical working distances and approach angles. However, how the position of the cervical spine influences the depths of surgical corridors and approach angles for the three approaches has not been evaluated. PurposeTo evaluate the depths of surgical corridors and the approach angles for the three endoscopic approaches, taking the influence of cervical spine position into account. Study designA radiographic study comparing three anterior endoscopic approaches to the craniovertebral junction. Patient sampleCervical extension and flexion radiographs for 34 patients and cross-sectional computed tomography scans for 30 additional patients were assessed. Outcome measuresThe depths of the surgical corridors and the approach angles for the three endoscopic approaches in the midsagittal planes. MethodsWe determined the mean angles of the surgical trajectories for the endoscopic transoral and transcervical approaches on cervical extension and flexion radiographs. In addition, we measured the depths of the surgical corridors and the approach angles for the three approaches in the midsagittal plane. ResultsThe average depths of surgical corridors were as follows: endonasal, 93.65 mm; transoral, 85.27 mm; transcervical, 62.97 mm (in extension). The average approach angles were as follows: endonasal, 31.22°; transoral, 30.87°; transcervical, 36.58° (in extension). ConclusionsThe position of the cervical spine does not influence the surgical convenience of the endoscopic transnasal approach, but it can influence the endoscopic transoral and transcervical approaches, especially the latter. The endoscopic transcervical approach offers several advantages over the endoscopic transoral and endonasal approaches.

Morphologic Differences in Intervertebral Foramina: A Radiographic Study of Cervical Spine Positions in Asymptomatic Men

ObjectiveThe purpose of this study was to investigate morphologic differences using plain film radiographs in cervical intervertebral foramina (IVF) for the following positions: neutral; flexion combined with lateral flexion to the right, rotation to the left (FLFR-RL); and flexion combined with lateral flexion to the right, rotation to the right (FLFR-RR.) MethodsFifteen participants (male; age, 22-29 years) with no history of neck pain were recruited to participate in this study. Radiographs were taken with participants standing and their cervical spines positioned in neutral, in FLFR-RL, and in FLFR-RR. Foraminal height and width were measured at levels C5/6 and C6/7 by a radiologist. Differences in IVF sizes between positions were analyzed. ResultsThe FLFR-RL position (flexion with contralateral rotation and lateral flexion) increased IVF height at C5/6 by 2.40 mm (24 %; P < .01) and C6/7 by 2.64 mm (26%; P < .01) compared with the neutral position. However, no significant increase in foraminal width was observed compared with the neutral position (P > .05), and no significant difference in foraminal height and width increase was observed between FLFR-RL and FLFR-RR. ConclusionThe results of this study demonstrate that the cervical FLFR-RL position increases the height of the cervical IVF as measured on radiographs.

스마트폰 사용시간이 목뼈 및 허리뼈의 굽힘각도와 목뼈의 재현오차에 미치는 영향

The purpose of this study was to assess the influence of the duration of smartphone usage on cervical and lumbar spine flexion angles and reposition error in the cervical spine. The study included 18 healthy smartphone users (7 males and 11 females). We measured the kinematics of the upper and lower cervical and lumbar spine flexion angles and the reposition error of the upper and lower cervical spine after 3 s and 300 s smartphone use in sitting. A paired t-test was used to compare the effects of the duration of smartphone usage on the kinematics of cervical and lumbar spine flexion angles and reposition error. The flexion angles of the lower cervical and lumbar spine and the reposition error in the upper and lower cervical spine were significantly increased after 300 s smartphone of use (p<.05). However, the flexion angle of the upper cervical spine was not significantly different between the 3 s and 300 s smartphone of use (p>.05). These findings suggest that prolonged use of smartphones can induce changes in cervical and lumbar spine posture and proprioception in the cervical spine.

A Study of Cervical Spine Posture in Female Pre School Teachers

Aims and Objectives: To analyze cervical spine posture in female preschool teachers Methodology in Brief: 100 females were selected as per the inclusion criteria. Participants were seated on a stool with their feet on the floor. They were suitably disrobed for the markers to be placed on the ear canthus, inferior end of both the ears, C7 vertebra. Then the digital photographs from side and front were taken and analyzed on the software URTHSCSA3 to calculate the Craniovertebral angle and anterior head alignment. Results: This study shows that there is a significant change in Craniovertebral angle, and Anterior Head Alignment. Conclusion: This study conclude that there is a higher tendency of forward head posture and left side lateral tilting of head in preschool teachers

Transcranial Doppler sonography as a potential screening tool for preanaesthetic evaluation

Intraoperative cervical spine rotation may compromise cerebral blood flow in susceptible individuals by distortion of cervical arteries. To investigate the effect of five cervical spine positions on cerebral blood flow in the middle cerebral artery. Prospective observational study. University hospital. Fifty-six male and 24 female patients scheduled for general anaesthesia for routine surgery. Exclusion criteria were cranial spine pathology and cerebral vascular disease. Maximum rotation of the head to the left and right side with and without hyperextension, and hyperextension in the neutral position. Change of mean blood flow velocity in the middle cerebral artery measured by transcranial Doppler sonography. Age had a significant effect on mean blood flow velocity in the left middle cerebral artery in the neutral position (P = 0.047). There was a significant difference in mean blood flow velocity in the left middle cerebral artery between patients younger than 40 years and patients older than 59 years [61.2 (16.6) ml min(-1) vs. 47.7 (16.2) ml min(-1); P = 0.015]. There was a significant effect of head position on mean blood flow velocity in both the left and in the right middle cerebral arteries (P = 0.039 left, P = 0.025 right). Twenty patients had a decrease of more than 20% from their baseline mean blood flow velocity. Neck rotation and/or extension resulted in a significant change of blood flow in the middle cerebral artery.

Influence of Cervical Spine Position, Turning Time, and Cervical Segment on Cadaver Intradiscal Pressure During Cervical Spinal Manipulative Therapy

ObjectiveThe purpose of this study was to determine influences of cervical spine positions, turning times, and cervical segments on cadaver intradiscal pressure (IDP) during cervical spinal manipulative therapy (SMT). MethodsWe simulated cervical SMT with stretching and rotation on 7 fresh adult cadaver specimens in the material test system machine. The changes in IDP for cervical intervertebral disks (C3/4, C4/5, and C5/6) during 4 different stages of cervical SMT (physiologic state, end of the traction stage, turning stage, and finish time) were monitored. Five different cervical positions (extension 20°, extension 10°, neutral position, flexion 10°, flexion 20°) and 3 different turning times (0.06, 0.11, 0.16 second) of IDP were monitored, using micropressure sensors. ResultsThe variable tendency of cervical IDP presents a “V”–shaped curve during SMT. The 4 stages of SMT had significantly different IDP (F = 5498.956; P < .001). There were also significant differences in IDP between 5 cervical positions ([F = 1371.216; P < .001], [flexion 20° > flexion 10° > neutral position > extension 10° > extension 20°]), 3 turning times ([F = 419.530; P < .001], [0.06 > 0.11 > 0.16 seconds]), and 3 cervical segments ([F = 84.282; P < .001], [C3/4 < C4/5 < C5/6]). Intradiscal pressure was lowest at 20° extension combined with a turning time of 0.16 second. ConclusionDifferent cervical positions, turning times, and cervical segments largely influence IDP during the process of SMT. Further research using human subjects should determine if these findings contribute to greater patient comfort, safety, and clinical efficacy with SMT.

Effect of cervical spine position on upper limb myoelectric activity during pre-manipulative stretch for Mills manipulation: A new model, relations to peripheral nerve biomechanics and specificity of Mills manipulation

Objectives(A) Describe a new method of investigation of the possible muscular effects of the commonly practiced Mills manipulation for lateral elbow pain (epicondylalgia), (B) ascertain if myoelectric activity is influenced during the pre-manipulative stretch for Mills manipulation, (C) establish whether muscle responses are influenced by ipsilateral lateral flexion of the cervical spine which reduces mechanical tension in the peripheral nerves of the upper limb. SampleEight asymptomatic subjects were tested bilaterally (N=16). MethodsMyoelectric measurements – EMG signals were recorded with a 16 channel pocket EMG patient unit and processed off-line. Measurement of joint positions-three CCD adjustable cameras sensitive to 10mm reflective passive markers applied at specific locations on the subjects’ bodies were used to reconstruct and verify accuracy of body movements and were correlated with EMG recordings. ResultsCompared with the standard (anatomical) position of the cervical spine in which Mills manipulation is typically performed, cervical spine ipsilateral lateral flexion produced significantly reduced activity in muscles that restrain the manipulation movement (elbow extension), namely biceps brachii (P=0.018) and brachioradialis (P=0.000). The affected muscles may therefore produce protective effects during the manipulation. ConclusionsChanges in myoelectric activity were in a pattern that suggests that muscle and neural mechanisms may be an integral part of the Mills manipulation. Cervical spine ipsilateral lateral flexion may be used to reduce mechanical stresses in the peripheral nerves and extraneous muscle activity, making Mills’ manipulation potentially safer and more specific.

Associação entre os sintomas da disfunção temporo-mandibular com factores psicológicos e alterações na coluna cervical em alunos da Escola Superior de Saúde Jean Piaget do Algarve

IntroductionThe temporomandibular disorder (TMD) affects the tempomandibular joints and stomatognathic apparatus mastication muscles and associated structures. The mastication muscles spasm is the main cause of painful symptoms in TMD; this situation may be induced by deleterious habits, which can be triggered or aggravated by emotional stress. In addition to psychological factors, cervical spine postural alterations may lead to jaw repositioning and structural changes in the whole temporomandibular joint (TMJ), causing TMD. National studies on the TMD prevalence and its relation with postural changes and levels of anxiety and depression are unknown. ObjectiveThe objective of this study was to investigate the prevalence of TMD and its association with psychological factors, particularly anxiety and depression, and also postural changes in the cervical spine, in students from the Jean Piaget-Algarve Health School. Material and methodsThe sample comprised 306 students of Physiotherapy, Nursing, Pharmacy and Clinical Analysis and Public Health BScs, from both genders, aged 18 to 43 years. TMD (using Fonseca Anamnesic Questionnaire), Anxiety and Depression and cervical spine posture were evaluated once during the 2009/2010 academic year. Results and discussionThe results indicated a TMD prevalence of 37.3% and 18.3% of anxiety or depression. The postural evaluation showed that 36.6% of students had correct cervical curvature and 19.6% had cervical concavity. No statistically significant relation (p>0.05) was found between the presence of TMD and cervical spine changes. However, the association between TMD and anxiety and depression, showed that from the 114 students (37.3%) who had TMD symptoms, 35 (11.4%) also showed anxiety or depression signs (statistically significant; p<0.05). ConclusionThis study showed that the Jean Piaget-Algarve Health School students’, from various health courses, present a high TMD prevalence, and revealed a significant association between this dysfunction and anxiety or depression levels. It is of great importance to disclosure this subject to populations’ submitted to great emotional stress, such as university students, in order to improve individual self awareness to TMD signs and symptoms.

Assessment of Cervical Spine Positioning and Immobilization Accuracy using a Novel Relocatable Head Frame Intended for Intra-cranial Stereotactic Radiotherapy

Assessment of Cervical Spine Positioning and Immobilization Accuracy using a Novel Relocatable Head Frame Intended for Intra-cranial Stereotactic Radiotherapy

Enhanced External Counterpulsation and Traction Therapy Ameliorates Rotational Vertebral Artery Flow Insufficiency Resulting From Cervical Spondylosis

Clinical trial of patients with rotational vertebrobasilar insufficiency (VBI) resulting from cervical spondylosis. To investigate the effectiveness of enhanced external counterpulsation (EECP) and traction therapy for these patients. EECP would reduce arterial stiffness and vascular resistance, and increase regional blood flow of vertebral arteries, thus may ameliorate symptoms in these patients. One hundred sixty-three patients who were clinically suspected rotational VBI caused by cervical spondylosis were enrolled in this study. They were randomly allocated into 3 groups: EECP + traction, EECP, and traction group. All patients and 50 healthy volunteers received transcranial color Doppler examination of the vertebral artery and basilar artery in both a neutral cervical spine position and a rotational position. Within 3 days after treatment, 47 (84%) patients in EECP + traction group, 32 (61%) patients in EECP group, and 8 (15%) patients in traction group achieved successful outcomes, while at 3 months' follow-up, 45 (80%) patients in EECP + traction group, 34 (64%) in EECP group, and 3 (6%) in traction group achieved successful outcomes. With head rotation, the percentage of reduction of blood flow velocities of the vertebrobasilar artery (VBA) in patients was much greater than that of the healthy volunteers (P < 0.01). After treatment, rotational blood flow velocity reduction percentage of VBA in each treatment group was much lower than that of each group before treatment. EECP + traction group experienced the greatest decrease of rotational blood flow velocity reduction percentage of VBA, while EECP group experienced second greatest. EECP and traction therapy can relieve the symptoms of rotational VBI, improve the rotational reduction of vertebrobasilar blood flow, and reduce the increased arterial impedance.