1. Diagnostic accuracy of premanipulative upper cervical
spine instability tests: a systematic review
Nathan Hutting MSc, Gwendolijne GM Scholten-Peeters PhD, Veerle Vijverman MSc, Martin DM Keesenberg MSc, Arianne P. Verhagen PhD
INTRODUCTION
• Cervical spine manipulative therapy (SMT) is often
used in the treatment of neck pain and headache.
• Most studies focus on cerebrovascular complications
of SMT.
• Less frequently on non-cerebrovascular
complications, such as upper cervical spine instability.
PURPOSE
To evaluate the diagnostic accuracy of the upper cervical
spine instability tests in patients or healthy subjects.
RELEVANCE
• There might be a potential for serious adverse events
for patients with an upper cervical spine instability
undergoing SMT.
• Minimize the risk of serious complications: screen
patients before using SMT.
• Little is known about the diagnostic accuracy of these
tests.
METHODS
• Search: PUBMED, CINAHL, EMBASE and The RECALL
Legacy databases (date of inception until October
2012).
• Data extraction: Two reviewers independently using a
standardized data extraction form.
• Evaluation of methodological quality: QUADAS-2 by 2
reviewers independently.
• Depending on heterogeneity, statistical pooling was
performed.
RESULTS
• Five studies were included.
• Identified tests are presented in Figure 1.
• Statistical pooling was not possible due to
heterogeneity.
• Sensitivity and specificity are presented in Figure 1.
• Positive and negative likelihood ratios of the tectorial
membrane and atlanto-occipital membrane tests
were sufficient.
• Tests for transverse ligament en alar ligaments
showed sufficient positive likelihood ratios.
CONTACT DETAILS
Nathan Hutting
nhutting@fysiotherapiehetcentrum.nl
Figure 1: Sensitivity and specificityCONCLUSIONS
• The tectorial membrane- and atlanto-occipital membrane
tests showed the best diagnostic accuracy.
• Applicability as premanipulative screening test for SMT in
general practice is uncertain.