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1.  Quantification of Cavitation and Gapping of Lumbar Zygapophyseal Joints during Spinal Manipulative Therapy 
Objectives
The purpose of this study was to use previously validated methods to quantify and relate 2 phenomena associated with chiropractic spinal manipulative therapy (SMT): 1) cavitation and 2) the simultaneous gapping (separation) of the lumbar zygapophyseal (Z) joint spaces.
Methods
This was a randomized, controlled, mechanistic clinical trial with blinding. Forty healthy subjects (18 to 30 years of age) without a history of low back pain participated. Seven accelerometers were affixed to the skin overlying the spinous processes of L1-L5 and the S1 and S2 sacral tubercles. Two additional accelerometers were positioned 3 cm left and right lateral to the L4/L5 inter-spinous space. Subjects were randomized into: Group 1–side-posture SMT (n=30) or Group 2–side-posture positioning (SPP, n=10). Cavitations were determined by accelerometer recordings during SMT and SPP (left-side=up-side for both groups); gapping (gapping difference) was determined by the difference between pre- and post-intervention MRI joint space measurements. Results of mean gapping differences were compared.
Results
Up-side SMT and SPP joints gapped more than down-side joints (0.69 vs. −0.17mm, p<0.0001). SMT up-side joints gapped more than SPP up-side joints (0.75 vs. 0.52mm, p=0.03). SMT up-side joints gapped more in males than females (1.01 vs. 0.49mm, p<0.002). Overall, joints that cavitated gapped more than those that did not (0.56vs. 0.22mm, p=0.01). No relationship was found between the occurrence of cavitation and gapping with up-side joints alone (p=0.43).
Conclusions
Z joints receiving chiropractic SMT gapped more than those receiving side-posture positioning alone, Z joints of males gapped more than those of females, and cavitation indicated that a joint had gapped, but not how much a joint had gapped.
doi:10.1016/j.jmpt.2012.06.007
PMCID: PMC3501577  PMID: 22902194
spinal manipulation; zygapophyseal joints; facet joints; cavitation; chiropractic
2.  Evaluating the Relationship among Cavitation, Z Joint Gapping, and Spinal Manipulation: An Exploratory Case Series 
Purpose
This IRB-approved project determined the feasibility of conducting larger studies assessing the relationship between cavitation and zygapophysial (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 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 A-P 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, 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 non-cavitation 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 mm vs. 0.4 ±0.5 mm).
Conclusions
A future clinical study is quite feasible. Forty subjects (30 SMT and 10 Control) would be needed for appropriate power (0.90). Partial funding by NIH/NCCAM (#2R01AT000123).
doi:10.1016/j.jmpt.2010.11.008
PMCID: PMC3582390  PMID: 21237402
3.  Distribution of Cavitations as Identified with Accelerometry during Lumbar Spinal Manipulation 
Objective
This project determined the location and distribution of cavitations (audible sounds producing vibrations) in the lumbar zygapophyseal (Z) joints that were targeted by spinal manipulative therapy (SMT).
Methods
This randomized, controlled, clinical study assessed 40 healthy subjects (20 male, 20 female), 18–30 years of age, that were block randomized into SMT (Group 1, n=30) or side-posture positioning only (Group 2, control, n=10) groups. Nine accelerometers were placed on each patient (7 on SPs/sacral tubercles of L1–S2 and 2 placed 3 cm left and right lateral to the L4/L5 interspinous space). Accelerometer recordings were made during side-posture positioning (Groups 1 and 2) and SMT (Group 1 only). The SMT was delivered by a chiropractic physician with 19 years of practice experience and included 2 high-velocity, low-amplitude thrusts delivered in rapid succession. Comparisons using chi-square or McNemar’s test were made between number of joints cavitating from: Group 1 vs. Group 2, up-side (contact side for SMT) vs. down-side, and Z joints within the target area (L3/L4, L4L5, L5/S1) vs. outside the target area (L1/L2, L2/L3, sacroiliac).
Results
Fifty-six cavitations were recorded from 46 joints of 40 subjects. Eight joints cavitated more than once. Group 1 joints cavitated more than Group 2 joints (p<0.0001), up-side joints cavitated more than down-side joints (p<0.0001), and joints inside the target area cavitated more than those outside the target area (p<0.01).
Conclusions
Most cavitations (93.5%) occurred on the up-side of SMT subjects in segments within the target area (71.7%). As expected, SMT subjects cavitated more frequently than side-posture positioning only subjects (96.7% vs. 30%). Multiple cavitations from the same Z joints had not been previously reported.
doi:10.1016/j.jmpt.2011.05.015
PMCID: PMC3215819  PMID: 21986305
4.  Genetic linkage and transmission disequilibrium of marker haplotypes at chromosome 1q41 in human systemic lupus erythematosus 
Arthritis Research  2001;3(5):299-305.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of autoantibodies to a wide range of self-antigens. Recent genome screens have implicated numerous chromosomal regions as potential SLE susceptibility loci. Among these, the 1q41 locus is of particular interest, because evidence for linkage has been found in several independent SLE family collections. Additionally, the 1q41 locus appears to be syntenic with a susceptibility interval identified in the NZM2410 mouse model for SLE. Here, we report the results of genotyping of 11 microsatellite markers within the 1q41 region in 210 SLE sibpair and 122 SLE trio families. These data confirm the modest evidence for linkage at 1q41 in our family collection (LOD = 1.21 at marker D1S2616). Evidence for significant linkage disequilibrium in this interval was also found. Multiple markers in the region exhibit transmission disequilibrium, with the peak single marker multiallelic linkage disequilibrium noted at D1S490 (pedigree disequilibrium test [PDT] global P value = 0.0091). Two- and three-marker haplotypes from the 1q41 region similarly showed strong transmission distortion in the collection of 332 SLE families. The finding of linkage together with significant transmission disequilibrium provides strong evidence for a susceptibility locus at 1q41 in human SLE.
PMCID: PMC64842  PMID: 11549371
1q41; autoimmunity; linkage; systemic lupus erythematosus; transmission disequilibrium

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