Cervical Spine

The Association Between Cervical Degenerative MRI Findings and Self-reported Neck Pain, Disability and Headache: A Cross-sectional Exploratory Study

By Frank M. Painter|October 12, 2023|Cervical Spine, Chronic Neck Pain|

The Association Between Cervical Degenerative MRI Findings and Self-reported Neck Pain, Disability and Headache: A Cross-sectional Exploratory Study

SOURCE: Chiropractic & Manual Therapies 2023 (Oct 11); 31: 45
Rikke K Jensen • Kristina B Dissing • Tue S Jensen • Stine H Clausen • Bodil Arnbak

Department of Sports Science and Clinical Biomechanics,
Center for Muscle and Joint Health,
University of Southern Denmark,
Odense, Denmark.

FROM: J. Clin. Med. 2021

Background: Neck pain and headache are highly prevalent conditions and leading causes of disability worldwide. Although MRI is widely used in the management of these conditions, there is uncertainty about the clinical significance of cervical MRI findings in patients with neck pain or headache. Therefore, this study aims to investigate the association between cervical degenerative MRI findings and self-reported neck pain, neck disability, and headache.

Methods: This study was a secondary analysis of a cohort of patients with low back pain aged 18-40 years recruited from a non-surgical outpatient spine clinic. The cervical MRI and outcome measures used in this analysis were collected at a four-year follow-up (2014-2017). Self-reported outcome measures included neck pain intensity, neck disability as measured by the Neck Disability Index, and headache as measured by a single NDI item. Cervical MRI findings included disc degeneration, disc contour changes, and vertebral endplate signal changes (VESC). Multivariable logistic regression analyses, adjusted for age and sex, were used to analyse the associations between MRI findings and neck pain, neck disability, and headache.

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Specific Potentialities of the Subluxation Complex

By Frank M. Painter|May 27, 2013|Cervical Spine, Diagnosis, Education, Subluxation|

Specific Potentialities of the Subluxation Complex

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 7 from RC’s best-selling book:

“Basic Principles of Chiropractic Neuroscience”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 7: Specific Potentialities of the Subluxation Complex

This chapter describes the primary neurologic implications of subluxation syndromes, either as a primary factor or secondary to trauma or pathology, within the cervical spine, thoracic spine, lumbar spine, and pelvic articulations.

GENERAL CONSIDERATIONS

Studies reported by Drum, Hargrave-Wilson, Kunert, Burke, Gayral/Neuwirth, and others have shown that a subluxation complex, often leading to spondylosis, can effect a wide variety of disturbances that may appear to be disrelated on the surface. Most of the remote effects can be grouped under the general classifications of nerve root neuropathy, basilar venous congestion, cervical autonomic disturbances, CSF pressure and flow disturbances, axoplasmic flow blocks, irritation of the recurrent meningeal nerve, the Barre-Lieou syndrome, and/or the vertebral artery syndrome.

This chapter describes many causes for and effects of a spinal subluxation complex. In clinical practice, however, causes and effects are rarely found as isolated entities. Several factors will usually be involved and superimposed on each other.

Innervation of the Spinal Dura

It has long been known that the spinal dura mater has an intrinsic nerve supply. Spinal meningeal rami are derived from gray communicating rami and spinal nerves. The spinal nerves contribute sensory fibers to the meningeal rami. Several meningeal rami enter each IVF, and most are located anteriorly to the sensory ganglia within the IVF.

Bridge found that these intrinsic nerve fibers reach the anterior surface of the dura by three main courses. Here the nerves divide into ascending and usually longer descending filaments that run longitudinally and parallel on the dural surface, and a considerable amount of nerve overlaps from adjacent segments. Finer filaments penetrate the dural substance where they subdivide.

Kimmel reported that most of these fibers penetrate the dura near the midline, while others enter laterally near the exiting spinal nerve roots. At each segment level, two or three nerves enter the spinal dura mater and contain only small nerve fibers. In contrast, Edgar/Nundy could determine no definitive nerve endings, but the nerves could be traced to the posterior aspect of the spinal dura. These observations help to clarify the wide distribution of back pain that is often found following protrusion of a single IVD.

Cervical Dura Attachments

Sunderland states that the nerve sheaths in the cervical region are not firmly attached to their respective foramina. Only the C4 C6 cervical nerves have a strong attachment to the vertebral column, and this is to the gutter of the vertebral transverse process. He believes that these observations have relevance to any local lesion that may fix, deform, or otherwise affect the nerve and its nroots to the point of interfering with their function, and they also may be important to traction ijuries of nerve roots.

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Successful Management of Acute-onset Torticollis in a Giraffe

By Frank M. Painter|March 20, 2013|Animal Chiropractic, Cervical Spine, Torticollis|

Successful Management of Acute-onset Torticollis in a Giraffe

The Chiro.Org Blog

SOURCE: J Zoo and Wildlife Medicine 2013 (Mar); 44 (1): 181-5

Liza I. Dadone, V.M.D., Kevin K. Haussler, D.V.M., D.C., Ph.D., Dipl. A.C.V.S.M.R., Greg Brown, D.V.M., Melanie Marsden, D.V.M., James Gaynor, D.V.M., Dipl. A.C.V.A., Dipl. A.A.P.M, Matthew S. Johnston, V.M.D., Dipl. A.B.V.P. (Avian), DellaGarelle, D.V.M.

Cheyenne Mountain Zoo,
Colorado Springs, Colorado 80906, USA

A 2-yr-old male reticulated giraffe (Giraffa camelopardalis reticulata) presented with severe midcervical segmental torticollis upon arrival as an incoming shipment. Despite initial medical management, the giraffe developed marked neck sensitivity, focal muscle spasms, and decreased cervical range of motion. Using operant conditioning to assist patient positioning and tolerance to cervical manipulation, a series of manually applied chiropractic treatments were applied to the affected cervical vertebrae in an effort to restore normal cervical mobility.

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Cervical Spine Trauma

By Frank M. Painter|May 15, 2012|Cervical Spine, Chiropractic Care, Evaluation & Management, Rehabilitation|

Cervical Spine Trauma

The Chiro.Org Blog

Clinical Monograph 18

By R. C. Schafer, DC, PhD, FICC

As with most parts of the body, traumatic effects in the forearm or wrist may occur abruptly (eg, fracture, strain, sprain) or be the result of long-term microtrauma (eg, tunnel syndromes, arthritis, entrapment by scar tissue).

The cervical spine provides structural stability and support for the cranium, and a flexible and protective column for movement and balance adaptation, along with housing of the spinal cord and vertebral arteries. It also allows for directional orientation of the eyes and ears. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the cervical region.

BACKGROUND

Whether induced by trauma or not, cervical subluxation syndromes may be reflected in total body habitus. IVF insults, and the effects of articular fixations can manifest throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the cervical spine, as may numerous brainstem disorders.

Common Injuries and Disorders of the Cervical Spine

Cervical spine injuries can be classified as

(1) mild (eg, contusions, strains);

(2) moderate (eg, subluxations, sprains, occult fractures, nerve contusions, neurapraxias);

(3) severe (eg, axonotmesis, dislocation, stable fracture without neurologic deficit); and

(4) dangerous (eg, unstable fracture-dislocation, spinal cord or nerve root injury).

Spasm of the sternocleidomastoideus and trapezius can be due to strain or irritation of the sensory fibers of the spinal accessory nerves as they exit with the C2–C4 spinal nerves. The C1 and C2 nerves are especially vulnerable because they do not have the protection of an IVF. Radicular symptoms are rarely evident unless an IVD protrusion or rupture is present.

Prevalence

Because of its great mobility, relatively small structures, and weight-bearing role, the cervical spine is a frequent site of severe spinal nerve injury and subluxation/fixations. A large variety of cervical contusions, Grade 1–3 strains and sprains, subluxations, disc syndromes, dislocations, and fractures will be seen as the result of trauma.

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Rehabilitation Monograph Page

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Sports Management: Neck and Cervical Spine Injuries

By Frank M. Painter|December 5, 2011|Cervical Spine, Diagnosis, Education|

Sports Management: Neck and Cervical Spine Injuries

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 22 from RC’s best-selling book:

“Chiropractic Management of Sports and Recreational Injuries”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 22: NECK AND CERVICAL SPINE INJURIES

Soft-Tissue Injuries of the Posterior Neck

Cervical Contusions, Strains, and Sprains

Contusions in the neck are similar to those of other areas. They often occur to the cervical muscles or spinous processes. Painful bruising and tender swelling will be found without difficulty, especially if the neck is flexed. Phillips points out the necessity of normally lax ligaments at the atlanto-axial joints to allow for normal articular glidding, thus making tonic muscle action the only means by which head stability is obtained.

Strains (Grades 1–3) or indirect muscle injuries are common, frequently involving the erectors. Flexion and extension cervical sprains are also common in sports (Grades 1–3), and usually involve the anterior or posterior longitudinal ligaments, but the capsular ligaments may be involved. In the neck especially, strain and sprain may coexist. Severity varies considerably from mild to dangerous. Anterior injuries are more common to the head and chest as they project further anteriorly, but a blunt blow from the front to the head or chest may result in an indirect extension or flexion injury of the cervical spine. Many cervical strains heal spontaneously but may leave a degree of fibrous thickening or trigger points within the injured muscle tissue. Residual joint restriction following acute care is more common in traditional medical care than under mobilizing chiropractic supervision.

Cervical sprain and disc rupture are associated with severe pain and muscle spasm and are more common in adults because of the reduced elasticity of supporting tissues. Pain is often referred when the brachial plexus is involved. Cervical stiffness, muscle spasm, spinous process tenderness, and restricted motion are common. When pain is present, it is often poorly localized and referred to the occiput, shoulder, between the scapulae, arm or forearm (lower cervical lesion), and may be accompanied by paresthesias. Radicular symptoms are rarely present unless a herniation is present.

Diagnosis and treatment are similar to that of any muscle strain-sprain, but concern must be given to induced subluxations during the initial overstress. Palpation will reveal tenderness and spasm of specific muscles. In acute scalene strain, tenderness and swelling will usually be found. When the longissimus capitis or the trapezius are strained, they stand out like stiff bands.

Extension Injuries. When the head is violently thrown backwards (eg, whiplash), the damage may vary from minor to severe tearing of the anterior and posterior ligaments. Severe cord damage can occur which is usually attributed to momentary pressure from the ligamentum flavum and lamina posteriorly, even without roentgenographic evidence. A facial injury usually suggests an accompanying extension injury of the cervical spine as the head is forced backward. Management of minor injuries requires reduction of subluxations, traction, physiotherapeutic remedial aid, a supporting collar for as long as postural muscles are inadequate for structural support, followed by graduated therapeutic exercises. (more…)

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The Posterior Neck and Cervical Spine

By Frank M. Painter|November 12, 2011|Cervical Spine, Diagnosis, Education|

The Posterior Neck and Cervical Spine

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 5 from RC’s best-selling book:

“Symptomatology and Differential Diagnosis”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 5: The Posterior Neck and Cervical Spine

Introduction

With the important exception of neurologic and vertebral artery syndromes, most of the disorders witnessed in the posterior aspect of the neck are musculoskeletal conditions. Of particular significance are the symptom complexes of cervical arthritis, deformities, disorders of muscle tone, IVD syndromes, spondylosis, vertebral subluxation, tumors, and the effects of trauma. It is helpful to keep in mind that tumors of the cervical spine are usually secondary and that chronic degenerative disc disease and congenital anomalies may be asymptomatic for many years.

Functional Considerations

Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the neck. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the brachial plexus and cervical spine.

The gross mechanical function of the neck is determined by analysis of joint motion and muscle strength.

EVALUATING JOINT MOTION OF THE NECK

Gross joint motion is roughly screened by inspection during active motions. When a record is helpful, it is usually measured by goniometry. The prime movers and accessories responsible for voluntary joint motion in the cervical region are shown in Table 5.1.

EVALUATING MUSCLE STRENGTH OF THE NECK

Muscle strength is recorded as from 5 to 0 or in a percentage and compared bilaterally whenever possible. The major muscles of the neck, their primary function, and their innervation are listed in Table 5.2.

Structural and Neurologic Considerations

The healthy posterior neck provides stability and support for the cranium, a flexible and protective spine for movement, balance adaptation, and housing for the spinal cord and vertebral artery. From a biomechanical viewpoint, primary cervical subluxation syndromes may reflect themselves in the total habitus; from a neurologic viewpoint, insults may manifest throughout the motor, sensory, and autonomic nervous systems. Unlike the lumbar region, cervical disc herniations are not frequently associated with severe trauma; however, traumatic nerve root or cord compression has a high incidence in this area.

A general classification of musculoskeletal disorders of the neck is shown in Tables 5.3, and the function of the nerves of the cervical plexus and the brachial plexus is shown in Tables 5.4 and 5.5.

Anomalies and Deformities

Gross anomalies are rarely seen in chiropractic practice unless well adapted to the individual’s life-style. Those cases that have biomechanical significance vary in severity from minor to severe and occur multiply or singly. The cause is purely genetic transmission in about 35% of cases, and the remainder is due to environmental factors or a mixture of genetic and environmental factors. (more…)

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