Absolute Red Flags include which of the following conditions?

• A. Vertebrobasilar insufficiency syndrome
• B. Radiculopathy with stable neurological signs
• C. Acute Arthropathies with no instability
• D. Bleeding disorders with no anticoagulant therapy

Answer: (A)

Vertebrobasilar insufficiency is considered an absolute red flag for cervical procedures because it signals compromised blood flow to the brainstem and posterior circulation. When the neck is moved or manipulated, the vertebral and basilar arteries can be further stressed or occluded, potentially triggering a brainstem or cerebellar stroke. Symptoms such as dizziness, vertigo, drop attacks, double vision, trouble speaking, limb weakness, or sudden imbalance that are provoked or worsened by neck movements strongly suggest this issue, and any cervical manipulation would pose an unacceptable risk.

The other options don’t carry the same definitive, immediate threat. Radiculopathy with stable neurological signs indicates nerve root irritation without rapid deterioration, so treatment can proceed with caution. Acute arthropathies without instability involve joint inflammation but no acute spinal instability, which is not an automatic contraindication. Bleeding disorders without anticoagulant therapy raise bleeding risk but are not universally prohibitive for all manual therapy; the approach depends on the specific procedure and location.