Radiologically Guided Mobilization in Patients With Foraminal Stenosis: Impact on C5-6 Cervical Intervertebral Foramen

Abstract

Background: Using CT guidance to determine the right direction of mobilization through studying the kinematics of intervertebral foramen will reduce the risk of mobilization during manual therapy interventions for cervical canal stenosis. Purpose: The first aim of the study was to use 3D CT to detect the proper directions of opening for C5-6 cervical intervertebral foramen. The second aim was to study the effect of mobilization on the dimensions of intervertebral foramen in case of cervical canal stenosis. Methods: The study included thirty male patients diagnosed with cervical degenerative disc disease with radiculopathy for at least three months up to one year and a control group of fifteen healthy subjects. Each participant was subjected to 3D CT scan from 6 separate positions in two visits to Radiology lab, 3 positions in each visit to avoid exposure overdose 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 foramen (IVF) width and height were measured from the 3D CT in each position for both affected and opposite IVF. The direction of CT scan volume was 45 degrees with para sagittal plane and 10 to 15 degrees below the transverse plane to visualize plan of IVF. Height and width of IVF were measured for intermediate foraminal zone in each position for both control and experimental groups. Findings: Mixed design MANOVA revealed that IVF Height and 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 IVF and surprisingly on the opposite side as well in all levels of IVF. Conclusions: Coupling motion behavior in FBI position produces foraminal opening and increases the height and width of IVF in all cervical levels in both affected and contralateral side. Although AR, LB, ECR positions increase the height and width of the IVF on the affected side, it causes significant narrowing of the IVF on the opposite side. Implications: 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.