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BACKGROUND: Positions of cervical rotatory manipulation mainly include flexion, neutral, extension and rotation direction. It is still not clear which positions are more beneficial for cervical rotatory manipulation to reduce facet joint displacement in treatment of cervical spondylotic radiculopathy. OBJECTIVE: To compare biomechanical effects of positions on reduction of facet joint displacement by cervical rotatory manipulation in treatment of cervical spondylotic radiculopathy. METHODS: A three-dimensional finite element model of the normal C5-C6 was constructed and validated. Cervical rotatory manipulation was simulated with rotation to the right side in flexion, neutral and extension, respectively. Displacement distributions in forward-backward and upward-downward directions of C5 bilateral inferior articular processes were compared among cervical rotatory manipulation performed in different positions. The same node in C5 inferior articular process of the reduced side was selected as reference point for displacement value. Displacement values in forward-backward and upward-downward directions of C5 inferior articular process of the reduced side were compared among cervical rotatory manipulation performed in different positions. RESULTS AND CONCLUSION: (1) With cervical rotatory manipulation performed in flexion, neutral and extension, ipsilateral C5 inferior articular process of rotation moved backward and downward while contralateral C5 inferior articular process of rotation moved forward and upward. Thus, the sliding trend of C5 inferior articular process was significantly correlated with the direction of rotation, but not with positions of flexion, neutral and extension. (2) When cervical rotatory manipulation was performed in flexion, neutral and extension, forward displacement of contralateral C5 inferior articular process of rotation was 1.32, 1.22 and 0.77 mm, respectively, and upward displacement was 1.49, 1.29 and 0.29 mm, respectively. (3) The findings showed that forward-upward displacement of contralateral inferior articular process of rotation was maximum in flexion, indicating that rotation to the healthy side in flexion might be more beneficial for cervical rotatory manipulation to reduce facet joint displacement in treatment of cervical spondylotic radiculopathy. [ABSTRACT FROM AUTHOR]