Relationship between the Duplex Doppler Ultrasound and a Questionnaire Screening for Positional Tolerance of the Cervical Spine in Subjects with Suspected Vascular Pathology: A Case Series Pilot Study.

Manual therapy healthcare practitioners routinely perform the vertebral artery test (VAT) to determine cervical positional tolerance and to screen for vertebrobasilar insufficiency (VBI) prior to manipulating the cervical spine. Because the safety and validity of the VAT has been questioned in the literature, the purpose of this study was to determine if a relationship existed between a new tool, the cervical positional tolerance questionnaire (CPTQ), and the duplex Doppler ultrasound findings for patients with suspected VBI. Subjects were 39 consecutive patients referred by their physician for a duplex Doppler ultrasound with suspicion of VBI. On the CPTQ, patients reported whether they avoided certain cervical positions due to symptoms consistent with VBI prior to undergoing the ultrasound. The CPTQ had a sensitivity = 1.00 (95% CI: 0.34-1.00); specificity = 0.78 (95% CI: 0.64-0.92); negative likelihood ratio = 0.00 (95% CI: 0.02-2.73); and positive likelihood ratio = 4.50 (95% CI: 1.67-7.89). The results of this case series study, while preliminary, are encouraging. Further research with larger sample sizes is warranted in the development of the CPTQ regarding pre-cervical manipulation clinical decision-making. Inclusion of subjects from a cohort including asymptomatic people (no suspicion of VBI) would also strengthen the screening ability of the CPTQ. In addition to duplex Doppler ultrasound, using a gold standard test of vertebral artery testing by way of magnetic resonance angiography (MRA) would further improve data on the diagnostic utility of the CPTQ.