Vertebral Artery and Cerebral Hemodynamics After Various Head Positions & Manipulation in Patients With Neck Pain

Completed

Phase N/A Results

Trial Description

The Investigators are performing a study to determine, in patients with chronic/recurrent neck pain, the cerebrovascular hemodynamic consequences of cervical spine movements, including manipulation, in vivo using fMRI technology on vertebral and cranial blood flow dynamics affecting brain perfusion, and extend the current data set on these variables

Detailed Description

The goal of the study is to further investigate in patients with chronic/recurrent neck pain, the cerebrovascular hemodynamic consequences of cervical spine positions, including manipulation, in vivo under clinically relevant circumstances using two advanced MRI technology on the vertebral and posterior cerebral and cerebellar blood flow dynamics affecting brain perfusion. According to the knowledge of the investigators, a study utilizing MRI to examine blood flow and perfusion, turbulence and evidence of micro-trauma within these blood vessels has yet to be conducted.

Conditions

Interventions

  • Head positions and spinal manipulation Other
    Intervention Desc: Each participant will undergo three separate test maneuvers. Neutral (0° rotation) neck position (condition 1) will be followed by block randomization between maximum voluntary rotation (condition 2) and a high-velocity-low-amplitude cervical manipulation targeted at C1-C2 (condition 3). Conditions 1 and 2 will be held for 1 minute before returning to neutral alignment. For the manipulation, the head will be repositioned at neutrality immediate. An experienced practitioner will perform the manipulation on the adjustable and pivotal MRI bed. After each condition, MRI of the upper neck and cerebrum for perfusion and blood flow will ensue.
    ARM 1: Kind: Experimental
    Label: Intervention group
    Description: Participants included in the experimental arm will be adults aged 18 years and older with chronic/recurrent neck pain Grade II averaging > 30% by Neck Disability Index (NDI) over the prior week who have been prescribed cervical manipulation for treatment of their condition. Each participant will undergo three separate test maneuvers consistent with prior work completed at the St. Joseph's Healthcare Hamilton Brain Body Institute. Each participant will begin with neutral cervical spine as a standard natural control, followed by block randomization between maximum voluntary rotation of the cervical spine and one cervical manipulation. Please see Intervention section for a detailed description.

Trial Design

  • Masking: Open Label
  • Purpose: Basic Science
  • Intervention: Single Group Assignment

Outcomes

Type Measure Time Frame Safety Issue
Primary Changes in blood flow through the vertebral artery and posterior cerebral and cerebellar circulation will be assessed using phase contrast MRI. The series of fMRI sequences will be performed on each participant immediately after each condition. Through study completion, data will be presented after an average of 1 year. No
Secondary Changes in tissue perfusion in the posterior cerebrum and cerebellum will be assessed using arterial spin labeling (ASL) MRI technique. The series of ASL sequences will be performed on each participant immediately after each condition. Through study completion, data will be presented after an average of 1 year. No
Secondary Changes in tissue oxygenation in the posterior cerebrum and cerebellum will be assessed using fMRI BOLD technique. The series of fMRI BOLD sequences will be performed on each participant immediately after each condition. Through study completion, data will be presented after an average of 1 year. No
Primary Changes in Blood Flow Through the Vertebral Artery and Posterior Cerebral and Cerebellar Circulation The series of fMRI sequences will be performed on each participant immediately after each condition. Through study completion, data will be presented after an average of 1 year.

Sponsors