Diagnosis of vertebral dislocation and subluxation
Symptoms of flexion dislocation of the cervical spine:
- the patient's head is tilted forward,
- the patient's chin almost touches the sternum.
Due to significant mobility and sharp pain in the back of the head, neck and shoulders, patients often hold their head with their hands while walking. When examining the spinous processes of the cervical spine, you can see the protrusion of the spinous process of the underlying vertebra. Above it, the depression of the overlying vertebra is felt. The anterior position of the overlying vertebral body makes swallowing difficult. A dislocated cervical vertebra can be felt through the pharynx or determined by laryngoscopy.
Computed tomography (CT) of the cervical spine shows anterior displacement of the C5 vertebral body after injury (indicated by an arrow).
A CT scan of the cervical spine reveals a fracture with dislocation of the C7 vertebra and interlocking of the facet joints.
With a unilateral rotational dislocation of the cervical vertebra, the position of the patient’s neck and head may be different, depending on the degree of dislocation. With an incomplete dislocation, the neck is extended and the head is tilted and turned to the healthy side. In case of complete dislocation, the patient's head is tilted towards the chest and towards the dislocation and turned (rotated) towards the healthy one. The spinous processes of the upper vertebrae will be deviated towards the dislocation. With both types of cervical vertebrae dislocations, accompanying neurological symptoms occur:
- changes in radicular sensitivity (hypoesthesia, paresthesia, analgesia),
- paresis and paralysis of the muscles of the upper limbs - as a result of compression or damage to the roots (mono- or paraparesis, paraplegia).
Paralysis of the muscles of four limbs (quadriplegia) will indicate damage to the spinal cord substance. The severity of such neurological symptoms is decisive for prognosis. Death is common.
With an MRI of the cervical spine, the lateral image shows a displacement of the C7 vertebral body and a fracture of the Th1 , forming compression of the spinal cord at this level after injury (indicated by arrows).
2. Reasons
The most common cause of vertebral dislocation is a mechanical blow to the neck from behind, or a fall upside down with a traumatic brain injury with the neck tilted anteriorly. Rotational (one-sided bending) dislocation is less common.
Typical situations in which victims receive such an injury are landslides in the mining industry or collapse of buildings, diving from a height in an unfamiliar place (where the depth is much less than expected), road traffic accidents, falls during exercises on gymnastic equipment (horizontal bars, uneven bars, rings, log). Sometimes a dislocation is caused by lifting an unbearable weight.
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Treatment of vertebral dislocation and subluxation
Reducing dislocation and subluxation of vertebrae is not an easy task even under anesthesia. Incomplete unilateral dislocations of the cervical vertebrae are reduced more easily - by stretching the neck behind the head (along the length of the body) using a Glisson loop and turning it in the opposite direction; complete dislocations of the cervical vertebrae, i.e. those where there is a “coupling”, need to be released from it by bending the head in the direction of the dislocation, followed by its rotation to the healthy one, with constant traction. Having released the grip and continuing traction, a reverse maneuver is performed: abducting the head to the healthy side, followed by rotation towards the dislocation.
The Gardner-Wells brace is used in emergency situations; The length of the neck is stretched through an adjustable block attached to a table transparent to X-rays.
It is recommended to first turn a flexion dislocation of the cervical vertebra into a rotational, unilateral one, and then reduce it. After reduction, a stabilizing operation is performed to fix the vertebrae (discectomy with anterior and posterior spinal fusion). For this purpose, various designs of fixing plates, implants (cages) and transpedicular fixing screws are used.
Most often in the cervical spine, such dislocations occur at the level of the C3 - C5 , C5 - C6 vertebrae, i.e. in the middle part of the cervical spine, where the overall anterior mobility is greatest. In the region of the two upper cervical vertebrae ( C1 and C2 ), where there are no cartilaginous discs and the joints are wide, they are strengthened by such a powerful ligamentous apparatus that dislocations at this level are a rare and exceptional occurrence. Dislocation of C1 vertebra (dislocation of the skull relative to the atlas), is possible either with a sharp flexion of the head, or with its rotation (rotation), which almost always ends in death.
The same can be said about dislocations of the C1 vertebra (atlas) relative to the underlying C2 vertebra (epistophea), if it is not accompanied by a fracture of its odontoid process. The cervical C2 vertebra is firmly connected to the anterior arch of the atlas ( C1 vertebra):
- transverse ligaments,
- pterygoid ligaments,
- cruciate ligaments with the anterior edge of the foramen magnum (foraminis occipitalis magni) in the occipital bone of the skull.
Wearing a neck brace (Philadelphia collar) for the treatment of sprained ligaments and injured joints of the neck.
When the head is tilted sharply with extension (for example, when hanging), these ligaments can rupture. When the C1 vertebra (atlas) is displaced forward, the odontoid process of the C2 vertebra crushes the spinal cord in the spinal canal, and instant death occurs. The broken odontoid process of the C2 vertebra is displaced forward with the anterior arch C1 vertebra (atlas), and in this case the spinal cord is not subject to compression. With increased flexion of the neck (hyperflexion), fractures of the bodies or articulated vertebrae are more often possible.
Conservative treatment for dislocation of the articular processes of the subaxial ( C3 - C7 vertebrae) cervical vertebrae consists of temporary immobilization of the neck for a period of 6 to 12 weeks. During this period of time, damaged ligaments, tendons and muscles of the neck, while at rest, have time to recover. Compliance with these deadlines is especially important for ligaments, because the metabolic process in them proceeds much slower than in muscles, in which the vascular network is well developed. To immobilize the cervical spine, a cervical corset (Philadelphia collar) or an external restraint system (Halo System) is used.
Wearing a cervical corset (Philadelphia collar) in the treatment of dislocation or subluxation of the articular processes of the cervical vertebrae.
Surgical treatment of dislocation of the articular processes of the cervical vertebrae is performed in two stages:
- immediate closed reduction of the dislocation, followed by MRI, then surgical stabilization of the cervical vertebrae;
- immediate MRI, then open reduction of the dislocation with surgical stabilization of the cervical vertebrae.
The sequence of these steps depends only on the clinical status of the patient and the type of damage present.
The first treatment option is applicable for unilateral or bilateral dislocation of the articular processes of the cervical vertebrae with neurological symptoms in conscious patients with adequate behavior. Closed reduction is not performed in patients with impaired consciousness and inappropriate behavior. Surgical stabilization follows successful closed reduction of the dislocation. Unilateral dislocation is technically more difficult to correct, but much more stable after reduction. Bilateral dislocations are technically easier to repair (due to rupture of the posterior longitudinal ligament), but are less stable after reduction.
After the reduction stage, an MRI examination and subsequent surgical stabilization of the cervical vertebrae are performed. Posterior transpedicular fixation and sometimes anterior discectomy with fixation can be performed in the absence of significant herniated protrusions of intervertebral discs. Anterior discectomy with fixation is always indicated for severe violations of the integrity of the intervertebral disc. About a third of all cases of closed reduction of dislocation of the articular processes of the cervical vertebrae may be ineffective and require the use of an open reduction technique.
Operation of posterior fixation of the cervical vertebrae and occipital bone in case of damage to the neck at the level of the axial vertebrae ( C1 - C2 ) and the cervical-occipital joint.
The second treatment option is applicable for unilateral or bilateral dislocation of the articular processes of the cervical vertebrae with symptoms in patients with impaired consciousness and inappropriate behavior. This option is also used in patients with a dislocation that could not be reduced using a closed method. An MRI examination is performed, followed by open reduction and stabilization of the cervical vertebrae. If the hernial protrusion is localized anteriorly, then a discectomy with an anterior approach is performed.
Techniques for eliminating dislocation of the articular processes of the cervical vertebrae:
Technique | Description of dislocation repair |
| Closed reduction | With axial traction of the cervical spine, adding a load gradually increases the force. Additional movement of neck flexion (tilting the head forward) can help reduce the dislocation. As the load (traction force) is added, a neurological examination and x-ray of the cervical spine are performed. If the patient's neurological symptoms worsen, traction of the neck is stopped and an MRI examination is performed. To perform closed reduction of vertebral dislocation, the following is required:
|
| Anterior open reduction and discectomy with fixation | This treatment method is indicated for:
Features of open anterior reduction:
|
| Posterior reduction and transpedicular stabilization | This treatment method is applicable for:
Features of open posterior reduction and transpedicular fixation:
|
| Combined anterior decompression and posterior reduction/stabilization | This surgical technique is indicated for anterior disc herniation requiring decompression in patients with a dislocation that was not corrected by closed or open anterior reduction. Features of the operation technique:
|
In the thoracic region, the spine, being connected to the ribs, is inactive and can only move after fractures of adjacent (articulated) vertebrae.
Operation of anterior fixation of the cervical vertebrae for damage to the neck at the level of the subaxial vertebrae ( C4 - C5 - C6 ).
The same can be said about the more mobile lumbar spine, strengthened by powerful long and short ligaments. The range of motion during flexion at the lumbar level of the spine is more pronounced than its rotation and tilt. In the lumbar vertebrae, the platforms of the articular processes are located in the frontal plane. This anatomical feature also prevents dislocation of the lumbar vertebrae during flexion.
Chronic sliding of the L5 body forward and down from the sacrum was first described by Killian under the name of spondylolysis and spondylolisthesis, and by Lambl under the name “self-dislocation of the spine.” Spodylolisthesis is an inevitable consequence of a congenital defect in the development of the vertebral arches (the area between the articular processes), most often found in the L5 vertebral arch. The clinical picture of spondylolysis and spondylolisthesis described by Turner occurs in both women and men. Clinical manifestations of this defect in the form of spondylolisthesis are observed under the influence of sudden physical activity, heavy lifting, etc. In women, repeated pregnancy can cause a gradual development of the same symptom (spondylolisthesis), because As the fetus grows, the ligaments soften. Softening the ligaments provides the necessary mobility of the joints of the pelvic bones for the smooth passage of the fetus during childbirth.
Exercises for displacement of the cervical vertebrae
The sooner treatment with dosed movement begins, the less time it takes to take medications, and sometimes it is possible to do without them completely.
Examples of simple exercises are given below:
- Starting position: lying on your back. Raise your head and hold it with your gaze fixed on your feet for a minute.
- The starting position is the same. Turn your head right and left at a slow pace.
Therapeutic gymnastics should be approached with all responsibility, since in case of problems with the musculoskeletal system, it can be harmful to health. Exercises should be done only on the advice of a doctor. In our clinic, an individual training plan is drawn up for each patient.
How to treat?
Therapy for subluxation primarily involves realigning the displaced vertebrae. This manipulation can be performed using techniques such as manual therapy, the application of the Rusche-Hüter principle or the Glisson loop. The reduction method is selected taking into account certain factors, for example, the patient’s health status, the presence of complications or concomitant pathologies.
On a note! Upon completion of the massage course, the doctor prescribes the child to wear a special product - a Shants collar or a plaster corset. This product must be worn for several months (about 1 to 5).
Shants collar
Shants collar
In parallel with manual therapy, the doctor prescribes conservative treatment. This allows you to speed up the healing process. This includes the following procedures:
- vitamin therapy;
- physiotherapy;
- acupuncture;
- therapeutic exercises and massage;
- use of painkillers.
Gleason loop
During the rehabilitation period after subluxation of the cervical vertebra, it is necessary to reduce the baby’s activity. This limitation will prevent possible relapses of the pathological condition, which can cause serious complications such as deterioration of visual function or unilateral paralysis.
If you want to learn in more detail about the technology of manual therapy for osteochondrosis of the cervical spine, you can read an article about it on our portal.
Prevention measures
There are certain preventive measures, following which, you can prevent subluxation of the cervical vertebra. First of all, they are aimed at preventing injury. Such events include the following:
- taking care of the health of the collar area (regular exercise, maintaining an active lifestyle);
- doing morning exercises;
Gymnastics for children is very important - Teach your child to warm up his neck muscles several times a day. This is especially true if he constantly sits at the computer;
- Before any type of physical activity, you need to thoroughly warm up your muscles and joints;
- the child’s diet should be balanced and contain sufficient amounts of vitamins and minerals;
- If pain occurs in the neck area, you should immediately call a doctor or take the child to the hospital. If we are talking about a baby who cannot describe his sensations, then he should be periodically shown to a doctor for preventive purposes.
Prevention of cervical vertebral subluxation
Subluxation of the vertebrae in the neck is a serious injury, which, if ignored, can negatively affect the condition of the child’s entire body. Therefore, if your baby begins to be very capricious for no particular reason or you notice pathological development of his neck, you should immediately seek help from a doctor. Only with timely therapy can the maximum effect be achieved and unpleasant consequences prevented.
Why is this dangerous?
Subluxation can cause serious problems, which will negatively affect the functioning of the body in the future. First of all, the musculoskeletal system, nervous and circulatory systems are affected. Subluxation can also disrupt the functioning of the digestive system, causing intestinal disorders. Therefore, one cannot ignore the signs of a pathological condition, but pay attention to their slightest manifestations. Pediatric pathology can lead to the development of the following complications:
- convulsions;
- memory impairment, inability to focus attention;
- increased fatigue;
- developmental delay;
- ophthalmological pathologies, for example, myopia or strabismus;
- flat feet;
- development of osteochondrosis, scoliosis and other diseases of the spine.
Scoliosis in a child
Orthopedic chair for children
Most of the above disorders can be prevented; the main thing is timely detection of subluxation and timely treatment.