Instability of the cervical spine in adults and children - symptoms and treatment

Instability of the vertebrae in the cervical spine is an unpleasant phenomenon that can greatly impair a person’s quality of life. Instability manifests itself in the form of excessive mobility between several cervical vertebrae. The pathology is accompanied by painful sensations in the neck and head. But the situation can be easily corrected if instability of the cervical spine in adults and children is diagnosed in time. Symptoms and treatment of pathology, as well as features of its course - all this will be discussed in this article.

Instability of the cervical spine in adults and children - symptoms and treatment

Causes of pathology

There are many different factors that can provoke pathological mobility of the cervical vertebrae.

There are many causes of cervical instability

The most common ones include:

• mechanical damage to the spine caused by various injuries . The cervical spine is considered the most vulnerable part, since the muscle corset in the neck area is quite weak;
• development of degenerative-dystrophic processes . As a rule, they develop against the background of osteochondrosis of the cervical spine;
• primary or secondary degeneration of cervical discs (deterioration of the statics of the spine, disruption of metabolic processes in the affected area, etc.);

  
  Degenerative changes in the cervical spine

• previous spinal surgery . As a result of a violation of the integrity of the supporting complexes, instability often occurs, and excessive physical stress on the back in the postoperative period only aggravates the situation, making instability of the cervical spine more pronounced;
• consequences of cervical dysplasia , as a result of which, during intrauterine development, improper formation of the cartilaginous tissues of the spine occurs.

What is instability

On a note! An inactive lifestyle can also lead to the development of pathology, since in the absence of sufficient load, the muscular corset weakens and the load on the back is distributed unevenly. Do not forget also about previous diseases, such as vertebral fistula, osteoporosis or osteomelitis - all of them can provoke instability of the vertebrae.

X-ray SHOP

Massage pillow for neck and shoulders

The article is devoted to the clinical features of the course of headaches in children and adolescents with existing functional disorders in the spinal motion segments of the cervical spine. The characteristics of headaches of vertebrogenic origin and treatment regimens are given.

Features of clinic and therapy of headache at children with functional disorders of the vertebral-motor segment cervical spine

The article focuses on the clinical features of the course of headache in children and adolescents with functional disorders in the spinal motion segments of the cervical spine. The characteristic headache vertebrogenic genesis and regimen were dated.

Headaches are one of the most common symptoms in clinical practice in children. A wide range of conditions accompanied by headaches and the variety of their clinical manifestations show the relevance of the problem of headaches and require active attention from both researchers and practitioners. It is known that 80% of European adults suffer from headaches [1, 2, 3]. For a long time it was believed that headaches in children are much less common than in adults. According to modern data, the frequency of headaches in children ranges from 40% to 75% in the population [4, 5, 6, 7, 8, 9, 10, 11, 12]. Today, the main attention of researchers is drawn to the problems of diagnosis and treatment of tension headaches and migraines in children [13, 14, 15, 16, 17, 18, 19, 20, 21, 22]. But even in the last century, the opinion was expressed that reflex tension of the neck muscles in pathology of the cervical spine in children can provoke tension-type headaches and negatively affect the course of migraine [23, 24].

A number of studies have shown that damage to the ligamentous-articular apparatus of the craniovertebral zone can lead to chronic instability with deformation of the bone canal of the vertebral artery and contribute to the development of vascular disorders in the vertebrobasilar region [25, 26, 27]. In addition, due to the special position between the base of the skull and the spine, the craniovertebral zone can have a significant reflex effect on the underlying structures of the spinal column and surrounding tissues, but due to this same special position, the craniovertebral junction itself can be adversely affected by pathologically altered underlying structures.

Materials and methods

105 children and adolescents aged 5 to 18 years with complaints of headache were examined. There is a predominance of girls - 64 (60.9%), the number of boys who applied was 41 (39.1%). All patients underwent a standard neurological and vertebroneurological examination, Doppler examination of blood flow in the internal carotid and vertebral arteries according to the generally accepted method, as well as MRI of the brain and cervical spine according to indications.

results

The examined children had several types of headaches. Headache as a manifestation of vertebrogenic pathology (sclerotomy) was diagnosed in 29 (27.6%) cases. The favorite localization was the frontotemporal region, less often the occipital region, more often symmetrically. The headache was provoked by a prolonged forced position of the head in a state of anteflexion (prolonged tilt of the head forward, for example, in class or when preparing homework); in a significant percentage of cases, a combination with neck pain was noted. The peculiarity of the headache was that it appeared closer to the afternoon, usually at the end of 2-3 lessons, against the background of the child’s “causeless” anxiety, which arose as a result of unsuccessful attempts to change the pathogenic position of the head. Another characteristic feature was the rapid disappearance of headaches (within an hour) when changing the position of the cervical spine and head and the absence of headaches during school holidays. To diagnose the type of headache described above, we used an anteflexion test [23], which consists of the following: the chin comes as close as possible to the chest and the head stays in this position for some time (1-2 minutes). If by the end of 2 min. a typical headache appears, the test is considered positive and indicates ligamentous pain, but if the headache appears at the beginning of the test, that is, almost instantly, then this is more indicative of blocking of the atlanto-occipital joint.

Vascular headaches of vertebrogenic origin (vertebral artery syndrome), which are characterized by one-sidedness and spread from the back of the head to the frontal region, were observed in 10 (9.5%) children. They were not very intense. To a greater extent, our patients with vertebrogenic vascular cephalgia were bothered by dizziness associated with movements in the cervical spine. In this case, a provocative test in the form of percussion stimulation of the projection point of the vertebral artery was used for diagnosis. With vertebral artery syndrome, the test was positive in all cases, which was expressed by the appearance of typical headache, dizziness, lightheadedness, nystagmus and increased instability in the Romberg position. A negative test result indicated a different genesis of the headache.

Angiodystonic headaches were diagnosed in 24 cases, accounting for 22.9%. Dystonic pain was localized in the frontotemporal region, had a pressing nature and low intensity, was provoked by emotional factors and changes in weather conditions, and usually stopped on its own, without the use of medications. Migraine attacks were observed in 11 (10.5%) children with a complaint of headache. They were distinguished by significant intensity, accompanied by sensitivity to light and sound, nausea, and often vomiting; an improvement in the condition was observed after sleep. A characteristic feature was the presence of migraine in one of the parents, most often in the mother.

Headaches associated with intracranial hypertension occurred in isolated cases and amounted to 4.8% (5 children). These patients indicated that the headache bothered them more strongly in the morning, had a bursting character and was accompanied by vomiting, which brought relief. In addition, in 14 (13.3%) cases, a tension headache was detected, which was characterized by sensations of compression and squeezing of the skull. It can be noted that this type of headache was more often observed in emotionally labile children or in unfavorable family situations. In a number of cases, one could speak of a mixed genesis of cephalgia: they were dystonic in nature, but were characterized by greater intensity, frequency, and were provoked by static-dynamic loads on the cervical spine. Such headaches were diagnosed in 23 (21.9%) cases.

Complaints of an asthenic nature were identified in 25 (23.8%) children, autonomic disorders (sweating, feeling hot) were identified in 48 (45.7%) cases. Some children indicated darkening in the eyes and a feeling of loss of consciousness that appears when moving from a horizontal to a vertical position. Only 12 (11.4%) children who applied complained of spinal deformities.

Pathology of the cervical spine (CS) was identified in all examined children and adolescents. Among the examined children, 84 (80.0%) actively complained of pain in the school of varying intensity. In addition to complaints of pain, the SHOP also complained of discomfort in the cervical spine in the form of a feeling of fatigue and a crunch in the neck. 34 (32.4%) children complained of feeling tired in the school. The feeling of fatigue in the neck in all cases was combined with a feeling of fatigue in the shoulder girdles, arose with prolonged static load or a monotonous forced position of the neck and head, disappeared with movement, light warm-up, that is, it bore all the features of a functional pathology. 24 (22.9%) children complained of a crunch in the neck that appeared when making movements in the school and was not accompanied by pain. The duration of complaints ranged from short-term episodes to several days. The duration of the complaints varied from a day to several years.

Manual diagnostics revealed functional blockades of the SMS in all examined patients. The favorite localization of functional blockades were the following levels: O - CI (19.0%), CIII - CIV (14.7%), CII - CIII (13.4%), CIV - CV (13.4%), CVII - ThI (11.3%) and ThII - ThIII (8.2%).

It is known that muscle syndromes play an important role in the formation of the clinical picture of SUD in adults. In our study, it can be noted that all those examined were diagnosed with muscular-tonic syndrome of one muscle or another. The most interested were the short suboccipital muscles - 95.2% of all patients. Grade 1 muscle tension predominated; on the right side, pain was significantly (p<0.05) more frequent and more pronounced. When palpating the tense short suboccipital muscles, a “typical” headache was reproduced in a number of patients.

The discussion of the results

The cervical spine is the most mobile and at the same time the most vulnerable part of the spine. A distinctive feature of the cervical spine is the presence of a bone canal through which the vertebral artery passes. In childhood, the articular processes CIII-CVI are located more horizontally than in adults. In addition, the uncovertebral joint (Luschka joint) does not normally occur until the age of 20. All these features create conditions for the easier occurrence of functional disorders at this level. The formation of cervicocranialgia in childhood appears to us as follows. Children, to a greater extent than adults, are susceptible to so-called minor injuries without violating the anatomical integrity of the osseous-ligamentous apparatus, which is associated with the peculiarities of the development of stato-coordinating functions. This is especially true for children who have minimal cerebral impairment as a result of various reasons. In addition, the structural features of the intervertebral disc, joints, spinal ligaments and the condition of the muscle corset play a significant role in the formation of clinical manifestations. Since the children's spine is intact, since dystrophic processes have not yet developed in it, it has sufficient plasticity to compensate for the function of the “switched off” SMS by increasing the load on neighboring segments. Under certain conditions (for example, inadequate static load, prolonged stay in one position, etc.), the blockade cannot resolve on its own and persists for a long time. Accordingly, hypermobility of the overlying and underlying SMS persists for the same time, in which functional blockades also develop compensatoryly over time. Thus, a vicious circle arises. Local overload in the segment negatively affects the trophism of the disc itself, as well as the growth zones, contributing to the early development of degenerative processes and vertebral deformities. This process is inevitably, due to the anatomical unity of the musculoskeletal system, accompanied by the involvement of the muscles of the affected region. At first, muscle participation is limited to a muscle-tonic reaction; later, over time, areas of local muscle hypertonicity and more severe neurodystrophic changes appear in tonically contracted muscles (as a result of changes in trophism).

All of the above changes are maximally manifested in conditions of primary inferiority of the central nervous system. As a rule, a neurological examination in children reveals mild changes in the neurological status in the form of changes in muscle tone, myatonic syndrome, peripheral cervical insufficiency syndrome, pyramidal insufficiency, hyperkinetic syndrome, increased awkwardness, difficulty maintaining balance in special tests. This fact indicates the interest of certain structures of the central nervous system.

Considering the above, the tactics of treating vertebrogenically caused cephalgia become clear when manual therapy techniques come to the fore. In our opinion, treatment should include several points: selective manual therapy; post-isometric relaxation; correction of motor stereotype; drug therapy and physical therapy aimed at reducing instability in the SMS of the cervical spine; massage, exercise therapy.

As is known, the fixation abilities of the musculo-ligamentous apparatus in childhood are much lower than in adults, therefore, when using general (non-specific) techniques of manual therapy, there is a danger of increasing compensatory hypermobility in the adjacent SMS, up to its transition to instability. Because of this, it is recommended to use only special techniques according to the level and direction of the blockade. In particular, in the area of ​​the craniocervical junction, rhythmic and pushing mobilization of segments C0-I, CI-II is used with the patient lying on his back. The use of positional mobilizations of the craniocervical junction in lateroflexion and parallel displacement is possible only in children of the older age group (over 10 years), since this technique involves the use of a clear rhythm of muscle contractions in combination with respiratory synergies performed by the patient. In the mid-cervical region, mobilization of rotation with counter-holding is most often used as a technique that allows resolving not only blockade of rotation, but also blockades of other directions. Mobilization at the level of the cervicothoracic junction is carried out using rhythmic bending towards limiting the range of motion and mobilization with counter-rotation. Tractional mobilization of the cervicothoracic junction with gripping the patient through hands clasped at the back of the head is possible only after 7 years, when the linear dimensions of the body of the patient and the doctor become commensurate.

Considering the pronounced changes in muscle tone and the presence of neurodystrophic changes, it is necessary to carry out appropriate measures. In particular, post-isometric muscle relaxation is widely used, which allows you to quickly and painlessly relieve pain associated with hypertonicity of individual muscles. In older children, the method of ischemic pressure can also be used to normalize muscle tone. In cases of identified relaxation of some muscles, they are activated using individually selected exercises.

The complex of drug therapy includes the following groups of drugs in age-specific dosages: biostimulants; potassium orotate; vitamins with microelements. Vascular medications are prescribed according to indications.

Physiotherapy methods for instability are recommended: SMT on the cervical spine in stimulating mode No. 7-10; UFO in suberythemal dose No. 5-7. If SMT is poorly tolerated (the appearance of a vascular headache), you can prescribe aminophylline electrophoresis to the cervical spine every other day, in this case the total number of physiotherapeutic procedures should not exceed 15. A tonic massage of the cervical-collar area No. 10-15 is indicated with a frequency of 1 time per 4-6 months. Therapeutic exercise (physical therapy) is aimed at strengthening the muscular corset of the cervicothoracic spine and is carried out daily 1-2 times a day for 7-10-15 minutes. The exercise therapy complex excludes exercises to develop the joints of the cervical spine. In addition, it is recommended to carry out IRT locally-segmentally in a stimulating mode.

In case of complications of cervicalgia with muscular-tonic and neurodystrophic syndromes, electrophoresis of novocaine is prescribed to the corresponding area No. 7-10; applications of dimexide with novocaine and ATP in the ratio 3:1 + 1 ampoule of ATP, 10-15 applications per course; novocaine blockade of trigger points; IRT.

It is recommended to carry out clinical observation of this category of patients 1-2 times a year until the end of the growth period.

B.E. Gubeev, D.Kh. Khaibullina

Kazan State Medical Academy

Gubeev Bulat Eduardovich – postgraduate student of the Department of Neurology and Manual Therapy

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Classification

Depending on the causative factor, instability of the cervical vertebrae can be divided into several types. Below are the most basic of them.

Table. Types of cervical instability.

Structure of the cervical spine

In some cases, surgical intervention may be required to eliminate spinal instability, but if the disease was detected in time, then conservative treatment methods can be used.

What is cervical spine instability?

This pathology in children occurs due to injuries, congenital defects and hereditary syndromes, destructive processes, as well as atlantoaxial blockage, which is caused by increased mobility of the constituent elements of the spinal column.

There are several types of instability:

• Postoperative . May be the result of improperly performed surgical intervention in the cervical-vertebral region.
• Dysplastic . This type of instability occurs due to improper formation of the spine in childhood.
• Degenerative . Develops after suffering dystrophic disorders. For example, after osteochondrosis or scoliosis.
• Post-traumatic . Appears after birth or acquired injuries. For example, when the obstetrician sharply pulled the neck or when the baby fell out of the crib due to the carelessness of the parents.

The disease occurs due to excessive stress on the neck muscles, when the muscle fibers, on the one hand, are in a state of hypotonicity (relaxed), and on the other, in a state of tension. Because of this, when turning the head, tense muscles squeeze out the vertebra, and this leads to its displacement.

Characteristic symptoms

It is not enough to know the causative factors that can cause pathology; you need to learn to recognize the signs of spinal instability. The earlier a pathology is identified, the greater the chances of its rapid and successful elimination. The most common signs indicating instability of the spine in the cervical region include:

• painful sensations in the neck area, which, as a rule, are periodic. The pain may worsen when turning the head or after intense physical activity;

  
  Neck and back of head hurt

• general body fatigue, tension in the neck. Even with minor physical activity, fatigue occurs;
• decreased sensitivity in some areas of the body;
• change in the shape of the spine (deformity). If the head is fixed in one position, the pain subsides, but with prolonged stay, deformation of the spine can occur. In rare cases, pathological changes are so strong that they can be noticed without any devices or tools;
• signs of neuralgia (the patient’s nervous system begins to react to the manifestation of pathology). Twitching or numbness in the limbs, a feeling of weakness in the arms, or frequent shooting sensations occur;

  
  Neuralgia

• severe dizziness, decreased visual acuity, and tinnitus. All these signs indicate pinching of the vertebral artery.

Second period (cervical region). Instability

When the first suspicious symptoms appear, you should seek help from a doctor as soon as possible. Only with a timely diagnostic examination and diagnosis can the signs of pathology be eliminated in the shortest possible period.

Diagnosis of vertebral instability

At the initial appointment, the neurologist must carry out:

• detailed interview with the patient, collection of anamnesis;
• palpation examination of the back, neck, limbs;
• assessment of skin sensitivity and muscle strength;
• assessment of tendon reflexes;
• special neurological tests (symptoms of tension in the nerve roots, assessment of spinal deformation in different functional positions of the patient).

The most informative hardware diagnostic methods today are:

• X-ray
• MRI
• REG (Rheoencephalography)

Diagnostic features

During the diagnostic examination, the doctor will examine all the patient’s symptoms and complaints. An X-ray of the spine may also be required. Pathological changes in the structure of the cervical vertebrae can be detected during a standard x-ray or using functional studies. We are talking about diagnostic procedures such as myelography, MRI or CT (computed tomography).

Use of CT myelography

Based on the results of the diagnostic procedures performed, the doctor will be able to make an accurate diagnosis and prescribe appropriate treatment. As noted earlier, the earlier the diagnosis is made, the greater the chance of rapid and effective therapy.

Treatment methods

If you want to learn in more detail the characteristic signs of instability of the cervical vertebrae, and also consider treatment methods, you can read an article about this on our portal.

When instability of the cervical spine is confirmed, doctors use different treatment methods. First of all, they try to cure the pathology using non-drug methods, for example, using therapeutic exercises or physiotherapeutic procedures. Often, in case of spinal instability, the patient is prescribed pharmaceutical drugs, the dosage and duration of treatment of which is prescribed by the attending physician. If none of the conservative methods help cope with the disease, doctors resort to surgical intervention. Now let's look at each of these methods separately.

Consequences

Delayed diagnosis of NSOP in children can lead to compression of the intravertebral vein. This can cause brain hypoxia and, as a result, mental retardation. It is also possible that there may be a lack of coordination, staggering when walking, and hypermobility of the cervical-collar area.

Due to the fact that the treatment is not carried out on time or is of poor quality, the headaches will intensify, there will be obvious sleep disturbances, irritability, anxiety, lethargy, as well as visual and hearing impairment.

Possible complications

Incorrect or untimely treatment of cervical instability can lead to serious complications, for example, arthrosis of the intervertebral joints or cervical osteochondrosis. In this case, the patient experiences pain in the back, which intensifies with physical activity or bending the body.

The disease can have serious complications

Lack of quality treatment can lead to severe headaches, irritability and insomnia, which significantly impairs the quality of life. In this case, visual acuity may decrease, coordination of movements may be impaired, lethargy and general weakness of the body may occur. Sometimes instability of the cervical vertebrae can be completely restored with the growth of osteophytes (bone tissue), but such improvements will lead to a decrease in the mobility of the spine or its complete loss.

How to treat vertebral instability

The key to success in the treatment of any spinal disease is an integrated approach. This is the only way to achieve a good and lasting effect. However, there is not and cannot be a single complex suitable for everyone. It all depends on the degree of displacement of the vertebra and symptoms (discomfort, pain, muscle weakness below the displacement zone, surges in blood pressure, etc.).

Among the methods successfully used in our clinic to restore vertebral stability:

• Osteopathy helps to gently return a displaced vertebra to its place for both adults and children. The doctor's hands cause absolutely no pain.
• Manual therapy - restores muscle balance in the body, normalizes muscle tone, and removes excessive stress from the spine and joints.
• Plasma therapy promotes the accumulation of platelets isolated from the patient’s own blood around the site of the disease. Platelets are natural stimulators of body tissue regeneration. This method is perfectly combined with almost any other treatment methods.
• Isometric kinesiotherapy - promotes spinal traction, due to which the vertebrae themselves assume a normal position, changing movement patterns to the correct ones.
• Acupuncture - relieves muscle spasms and pain, restores innervation and blood circulation.
• Hirudotherapy - thins the blood and promotes its flow with nutrients and oxygen to the source of pain.

And the most important thing is professionalism, not only of the attending physician, but also of the doctors performing the treatment procedures. Under no circumstances should you trust the treatment of vertebral instability to inexperienced massage therapists or chiropractors. These should be competent and experienced specialists working in the same team with the attending physician and other procedural doctors.

Trust your health only to trusted specialists!