Which condition is listed as a primary contraindication to HVLA due to the risk of neurological compromise?

Which condition is listed as a primary contraindication to HVLA due to the risk of neurological compromise?

• A. Grade I spondylolisthesis
• B. Disc bulge without instability
• C. Grade III/IV spondylolisthesis, traumatic instability, or post-surgical instability
• D. Idiopathic scoliosis without symptoms

Answer: (C)

The key idea is that HVLA manipulation becomes dangerous when the spine is unstable or structurally compromised, because abrupt thrusts can worsen neural compression or injure the spinal cord or nerve roots. In severe spondylolisthesis (Grade III/IV), one vertebra sits well out of alignment over the one below, often narrowing the spinal canal or foramina and creating a higher risk of neural injury if a rapid thrust is applied. The presence of traumatic instability or instability after surgery similarly indicates that the spinal segments aren’t able to maintain safe alignment under sudden forces, making neurological compromise more likely with HVLA. By contrast, mild slip (Grade I) or a disc bulge without instability typically does not involve enough structural compromise to automatically raise the risk of neural injury from a thrust, and idiopathic scoliosis without symptoms likewise lacks acute instability or compression.

The key idea is that HVLA manipulation becomes dangerous when the spine is unstable or structurally compromised, because abrupt thrusts can worsen neural compression or injure the spinal cord or nerve roots. In severe spondylolisthesis (Grade III/IV), one vertebra sits well out of alignment over the one below, often narrowing the spinal canal or foramina and creating a higher risk of neural injury if a rapid thrust is applied. The presence of traumatic instability or instability after surgery similarly indicates that the spinal segments aren’t able to maintain safe alignment under sudden forces, making neurological compromise more likely with HVLA.

By contrast, mild slip (Grade I) or a disc bulge without instability typically does not involve enough structural compromise to automatically raise the risk of neural injury from a thrust, and idiopathic scoliosis without symptoms likewise lacks acute instability or compression.