Petautschnig Klaus.pdf - Osteopathic Research

Abstract (English)
Background: Before a cervical manipulation is executed in the osteopathic practice
the De Kleyn test is carried out as safety test. However, different opinions exist with
regard to haemodynamics of the vertebral artery in different positions of the head.
Aim: The aim of this study is to evaluate changes in haemodynamics during the De
Kleyn position, end-of-range rotation and the pre-manipulative position for C3/C4.
Method: 23 healthy volunteers without risk factors aged between 20 and 45 years are
selected as test persons and their vertebral artery is examined in the neutral position
of the head, in end-of-range rotation, in the end-of-range position of the De Kleyn test
and in the pre-manipulative position for C3/C4. The maximum speed of blood flow and
the diameter of the contralateral vertebral artery during the different head positions are
measured and the volume of blood flow is also established. On one occasion the test
persons are examined in the supine position and in the different head positions with
the ultrasonic device Vivit 7 Pro with a linear transducer with 10MHz at the level of
C3/C4. The measurements of the haemodynamics of the vertebral artery are carried
out with angle correction.
Results: In the De Kleyn position no significant change in the maximum speed of
blood flow of the right (p=0.66) and left vertebral artery (p=0.47) can be observed. In
contrast, the end-of-range rotation provokes a significant reduction of the maximum
speed of contra-lateral blood flow of the right (p=0.001) and left vertebral artery
(p=0.002). Also the pre-manipulative position for C3/C4 ensues a significant reduction
of the maximum contra-lateral speed of blood flow of the right vertebral artery
(p=0.009) and a clear decrease of the maximum contra-lateral speed of blood flow of
the left vertebral artery (p=0.09).
Discussion: A significant and obvious influence of the end-of-range rotation and the
pre-manipulative position can be observed on both sides, while the end-of-range De
Kleyn position does not have a significant influence on the blood flow of the vertebral
artery. Thus the value of the De Kleyn position as safety test needs to be questioned.
Key words: vertebral artery, speed of blood flow, De Kleyn test, cervical spine,
manipulation
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