EFFECT OF RAIDOLOGICAL GUIDED MOBILIZATION ON CERVICAL INTEVERTEBRAL FORAMEN IN PATIENTS WITH CANAL STENOSIS: PART 1 PRE-TREATMENT MEASUREMENTS

M. Mohamed Aly¹, S. Hafez Hassan¹, A. Farag², W. Shendy¹

¹Cairo University, Physical Therapy for Neurology and Neurosurgery, Cairo, Egypt, ²Cairo University, Department of Biomechanics, Cairo, Egypt

Background: Applying specific opening mobilization of cervical intervertebral foramen is still unclear as well as the effect of mobilization on intervertebral foramen dimensions. Using CT guidance to determine the right direction of mobilization through studying the kinematics of intervertebral foramen will enhance better results and less risk of mobilization during manual therapy interventions for cervical canal stenosis.

Purpose: The first aim of the study is to study the effect of coupling motion behaviour on the dimensions of intervertebral foramen in case of cervical foraminal Stenosis. The second purpose is to use 3D CT to detect the proper directions of opening mobilization for cervical intervertebral foramens.

Methods: Thirty male patients diagnosed with cervical degenerative disc disease and radiculopathy for at least three months up to one year have been included. Their ages ranged from 25 to 40 years, body weight ranged from 75 to 90kg and height ranged from 175 to 185 cm. A control group of 15 healthy subject has been included. Both groups have been subjected to 3D CT scan from 6 separate positions in two visits to Radiology lab, 3 positions in each visit to avoid overdose of exposure to X ray. The six positions were: Neutral (N) position, Lateral bending (LB), Axial rotation (AR), Flexion, lateral bending with ipsilateral rotation (FBI), Flexion, bending and contralateral rotation (FBC), and Extension with contralateral rotation (ECR). Intervertebral foramens (IVFs) width & Hight have been measured from the 3D CT in each position for both affected & opposite IVFs. Direction of CT scan volume was 45 degrees with para sagittal plan and 10 to 15 degrees below the transverse plane to visualize plan of IVFs. Hight and width of IVFs have been measured for intermediate foraminal zone from both sides of its medial and lateral surface in each position for both control and experimental groups. Hight was measured as the distance between upper and lower pedicle. Width was measured as distance between upper border of facet joint and upper border of uncinate process.

Results: Mixed design MANOVA revealed that IVFs Hight & width in the affected side increased significantly (P < 0.05) in positions AR, LB, FBI and FBC in both experimental and control groups compared with Neutral position. However, position (FBI) showed best results among them in the affected IVFs and surprisingly on the opposite side as well in all levels of IVFs.

Conclusions: Coupling motion behaviour in FBI position produce foraminal opening and increases the hight and width of IVFs in all cervical levels in both affected and contralateral side. Although AR, LB, ECR positions increases the hight and width of the IVFs on the affected side, it causes significant narrowing of the IVFs on the opposite side.

Implications: Based on the results of the current study It is recommended that Manual therapy interventions in the form of mobilization and manipulation should consider the clinical value of FBI position during physical therapy management of cervical foraminal stenosis especially bilateral affection. Whereas AR, LB, ECR should be used only in case of unilateral foraminal stenosis.

Funding acknowledgements: ElRazzy Spine Physical Therapy and Rehabilitation Clinics.

Keywords:
intervertebral foramen
cervical foraminal stenosis
coupling motion behaviour

Topics:
Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: Cairo University

Committee: Faculty of physical therapy Research Ethical committee

Ethics number: P.T.REC/012/003793