Which of the following is an absolute contraindication to HVLA cervical manipulation?

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Multiple Choice

Which of the following is an absolute contraindication to HVLA cervical manipulation?

Vertebral artery disease is an absolute contraindication to HVLA cervical manipulation because the rapid thrusts and cervical rotation/extension involved can injure the vertebral arteries, especially when there is underlying stenosis, dissection, or atherosclerotic plaque. The arteries run through the upper cervical spine, and a dissection or occlusion can compromise blood flow to the brainstem and posterior cerebral circulation, risking vertebrobasilar stroke. If vascular pathology is present or suspected, HVLA in the neck must be avoided, and safer alternatives or referral for imaging and evaluation should be pursued. The other scenarios describe conditions that may be evaluated or treated with caution, but they do not carry the same absolute risk of catastrophic arterial injury.

Vertebral artery disease is an absolute contraindication to HVLA cervical manipulation because the rapid thrusts and cervical rotation/extension involved can injure the vertebral arteries, especially when there is underlying stenosis, dissection, or atherosclerotic plaque. The arteries run through the upper cervical spine, and a dissection or occlusion can compromise blood flow to the brainstem and posterior cerebral circulation, risking vertebrobasilar stroke. If vascular pathology is present or suspected, HVLA in the neck must be avoided, and safer alternatives or referral for imaging and evaluation should be pursued. The other scenarios describe conditions that may be evaluated or treated with caution, but they do not carry the same absolute risk of catastrophic arterial injury.

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