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J Manipulative Physiol Ther. 2010 May;33(4):279-85. doi: 10.1016/j.jmpt.2010.03.005.

Validity of the posterior-anterior middle cervical spine gliding test for the examination of intervertebral joint hypomobility in mechanical neck pain.

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Osteopathic School of Madrid, Spain.



The purpose of this study was to determine if the posterior-anterior cervical gliding test is a valid test as compared with dynamic radiographic assessment in flexion/extension as tool for the manual diagnosis of intervertebral joint hypomobility in the midcervical spine in patients with mechanical neck pain.


The study was done according to Standards for Reporting of Diagnostic Accuracy guidelines. Fifty patients with mechanical neck pain participated. An examiner performed a posterior-anterior cervical spine gliding to determine the presence of joint hypomobility over the C3-C4, C4-C5, and C5-C6 levels. Two dynamic radiographs in flexion/extension of the neck were obtained from each patient. The angle resulting from the intersection of 2 lines traced between 2 consecutive vertebrae was considered the degree of intersegmental motion of flexion-extension between those vertebrae. Intersegmental motion showing radiographic data below mean - SD from normative data was considered to reflect hypomobility. Differences between hypomobile and not hypomobile segments were assessed with the 2-tailed unpaired Student t test. Sensitivity, specificity, positive predictive value, and negative predictive value were also obtained.


At all cervical segments, those patients diagnosed with hypomobility showed significantly (P < .001) lower radiographic motion (C3-C4: 12.4 degrees +/- 2.7 degrees, C4-C5: 14.5 degrees +/- 2.6 degrees, C5-C6: 15.0 degrees +/- 4.8 degrees) compared with those patients not diagnosed with hypomobility (C3-C4: 17.6 degrees +/- 3.8 degrees, C4-C5: 19.4 degrees +/- 3.4 degrees, C5-C6: 21.0 degrees +/- 3.8 degrees). The C3-C4 and C4-C5 levels had high sensitivity (>80%) and specificity (>70%), whereas C5-C6 showed high sensitivity (100%) but low specificity (41%).


The posterior-anterior cervical gliding test was as good as dynamic radiographic assessment for the diagnosis of intervertebral hypomobility in the midcervical spine in this group of subjects.

[Indexed for MEDLINE]

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