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Evaluating the Relationship Among Cavitation, Zygapophyseal Joint Gapping, and Spinal Manipulation: An Exploratory Case Series

Evaluating the Relationship Among Cavitation, Zygapophyseal Joint Gapping, and Spinal Manipulation: An Exploratory Case Series

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SOURCE:   J Manipulative Physiol Ther. 2011 (Jan);   34 (1):   2–14

Gregory D. Cramer, DC, PhD, Kim Ross, DC, PhD, Judith Pocius, MS, Joe A. Cantu, DC, Evelyn Laptook, DC, Michael Fergus, DC, Doug Gregerson, DC, Scott Selby, DC, P.K. Raju, PhD

National University of Health Sciences,
Lombard, IL 60510, USA.

OBJECTIVE:   This project determined the feasibility of conducting larger studies assessing the relationship between cavitation and zygapophyseal (Z) joint gapping following spinal manipulative therapy (SMT).

METHODS:   Five healthy volunteers (average age, 25.4 years) were screened and examined against inclusion and exclusion criteria. High-signal magnetic resonance imaging (MRI) markers were fixed to T12, L3, and S1 spinous processes. Scout images were taken to verify the location of the markers. Axial images of the L4/L5 and L5/S1 levels were obtained in the neutral supine position. Following the first MRI, accelerometers were placed over the same spinous processes; and recordings were made from them during side-posture positioning and SMT. The accelerometers were removed, and each subject was scanned in side-posture. The greatest central anterior to posterior Z joint spaces (gap) were measured from the first and second MRI scans. Values obtained from the first scan were subtracted from those of the second, with a positive result indicating an increase in gapping following SMT (positive gapping difference). Gapping difference was compared between the up-side (SMT) joints vs the down-side (non-SMT) joints and between up-side cavitation vs up-side noncavitation joints.

RESULTS:   Greater gapping was found in Z joints that received SMT (0.5 ± 0.6 mm) vs non-SMT joints (-0.2 ± 0.6 mm), and vertebral segments that cavitated gapped more than those that did not cavitate (0.8 ± 0.7 vs 0.4 ± 0.5 mm).

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CONCLUSIONS:   A future clinical study is quite feasible. Forty subjects (30 in an SMT group and 10 in a control group) would be needed for appropriate power (0.90).

Key Indexing Terms:   Manipulation, Spinal, Zygapophyseal Joints, Chiropractic

From the FULL TEXT Article:


Figure 1 summarizes the theory upon which this study was designed. Gapping is the separation of the zygapophyseal (Z) joint articular facets that occurs during spinal manipulative therapy (SMT) and side-posture positioning. [1] Zygapophyseal joint gapping during SMT is considered by many to be beneficial because the separation of joint surfaces during gapping is thought to

(1)   break up connective tissue adhesions that develop in hypomobile Z joints [2-4] (steps 1-5b, Fig 1) and

(2)   stimulate afferent nerves that innervate the Z joint capsule and the small muscles of the spine, [5-7] resulting in reflex neurologic [5, 8-16] (steps 3-5a, Fig 1) and possibly immunologic [15, 17, 18] consequences.

Figure 2 summarizes the theoretical relationship between Z joint gapping and cavitation.

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