What are Vertebral Subluxations?

The subluxation of the lower cervical spine is usually caused by high-energy trauma. Violence causes a slight displacement between the facet joints. The symptoms of cervical subluxation vary. Mild patients have only local pain and limited mobility, and severe patients may have nerve root and cervical spinal cord injuries.

Basic Information

Visiting department

orthopedics

Common locations

Lower cervical spine

Common causes

High energy trauma

Common symptoms

Mild patients have only local pain and limited mobility, and severe patients may have nerve root and cervical spinal cord injuries.

Causes of cervical subluxation

When the cervical spine is subjected to flexion violence, or the cervical spine in the flexed position is subjected to longitudinal compressive force, the front compressive stress of the affected vertebral body increases, and the posterior structure of the cervical vertebra is subjected to tensile stress. During the forward flexion of the vertebral body, the instantaneous rotation center of the adjacent vertebral body is located behind the center of the intervertebral disc. At this time, the front part of the vertebral body is the fulcrum, and the side of the tensile stress is the joint capsule, interspinous ligament, and ligamentum flavum.

The continuous effect of bending and compressive forces can produce two situations: if the compression force is large, it may cause anterior collapse of the vertebral body, and sometimes may cause cervical disc herniation; if the violence does not cause vertebral body fracture, the joint on the side of tension stress Capsules and ligaments can be torn. In severe cases, the posterior longitudinal ligaments are also damaged.

Continuous external force causes the two joints of the upper cervical spine to slide forward and separate and shift. This forward sliding of the posterior facet joint is related to the pathological basis of the disc. If the intervertebral disc functions well in the process of stress, the instantaneous rotation center does not change, and the external force on the posterior facet joint is mainly tension. Only when the joint capsule is torn, dislocation is possible.

When the disc degenerates, its height decreases, the fiber rings and ligaments around the disc are loosened, and there are potential instability factors in the intervertebral segment. During the violence, the intervertebral body shifts or the center of instantaneous rotation moves back or down, and the cervical spine bends. Movement creates huge shear forces between the posterior facet joints and slides against each other, resulting in tearing of the ligament and tearing of the facet joint capsule. Damage to the posterior longitudinal ligament is also one of the reasons for impaired intervertebral disc function. After the external force is stopped, the contraction of the neck muscles can retract the subluxated joints into place, but there are also subluxations due to the impaction of the joint capsule or the small fractures.

Clinical manifestations of cervical subluxation

The symptoms of anterior subluxation of the cervical spine are relatively mild, mainly in local areas, such as easy neck fatigue, local pain, soreness, and fatigue; head and neck flexion and rotation are limited; neck muscle spasm, head and neck lean forward, and feel stiff; The spinous processes and spinous process spaces at the injured segment are swollen and tender, and there may be tenderness on the anterior side of the vertebra.

Symptoms of the nervous system are relatively rare, even if they occur, they are not serious, and sometimes they show symptoms and signs of nerve root stimulation. However, subluxation of the cervical spine is that it is easy to cause instability in the future, and the degeneration of the intervertebral disc is intensified. If this instability between vertebral bodies persists, according to Wolf's law, the vertebral bodies above and below the intervertebral disc must inevitably pass through bone hyperplasia, increasing the intervertebral contact surface to increase stability. Hyperplasia of the bone can cause the sagittal diameter of the spinal canal to become shorter, and in severe cases, it can compress the spinal cord and cause spinal cervical spondylosis.

Cervical subluxation

Acute lateral radiographs may show no abnormal signs. If the facet joint is still in a subluxed state, the lateral radiograph can show that the joint is abnormally arranged. Sometimes extension and flexion dynamic photography can be used to show the instability of the injured segment. Some people recommend that when shooting extension and flexion films, the patient lies prone or supine on an arched stent. When an intervertebral displacement is found, the diagnosis can be confirmed.
In addition to X-rays, some people use the moire pattern to observe and judge the presence or absence of cervical instability.

Diagnosis of cervical subluxation

Acute lateral radiographs may show no abnormal signs. If the facet joint is still in a subluxed state, the side film can show that the joint is abnormally arranged. Sometimes extension and flexion dynamic photography can be used to show the instability of the injured segment. When taking extension and flexion films, the patient lies prone or supine on an arched stent. When an intervertebral displacement is found, the diagnosis can be confirmed. If there is no abnormality in the lateral X-ray film during the acute phase, it may be possible to cover the dislocation for the cervical muscle protective spasm. The cervical brace may be temporarily protected. The X-ray examination may be performed one week after the injury, and late dislocation may be found.

In addition to X-rays, moire patterns can also be used to observe and judge the presence or absence of cervical instability.

Cervical subluxation treatment

Traction therapy

Traction can usually be reset, but cranial traction is not necessary. When traction, take the skull in the median position and weigh 2 ~ 3kg. After the film was confirmed to be reset, the traction was continued for 3 weeks. Since there is a tendency for severe instability after resetting, and it is easy to relapse, it should be fixed with head, neck and chest plaster after resetting for 2 to 3 months. After the plaster is removed, it is maintained by the neck brace for a period of time. Manual resetting is not advisable. If it is necessary to do so, you need to exercise caution to prevent aggravating injury.

2. Surgical treatment

Surgery is not recommended in the acute phase. If there is still instability of the injured segment at a later stage or with delayed spinal cord or nerve root compression, surgery should be performed. Anterior cervical disc removal, decompression and bone graft fusion were performed. If there is spinal cord compression, extended decompression and bone graft fixation should be performed.