Limits...
Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.

Steilen D, Hauser R, Woldin B, Sawyer S - Open Orthop J (2014)

Bottom Line: In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches.In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability.Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate.

View Article: PubMed Central - PubMed

Affiliation: Caring Medical and Rehabilitation Services, S.C., 715 Lake St., Ste. 600, Oak Park, IL 60301, USA.

ABSTRACT
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability.

No MeSH data available.


Related in: MedlinePlus

Atlanto-axial rotational instability. The atlas is shown in the rotated position on the axis. The pivot is the eccentrically placed odontoid process. In rotation, the wall of the vertebral foramen of Cl decreases the opening of the spinal canal between Cl and C2. This can potentially cause migraine headaches, C2 nerve root impingement, dizziness, vertebrobasilar insufficiency, 'drop attacks; neck-tongue syndrome, Barré-Liéou syndrome, severe neck pain, and tinnitus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4200875&req=5

Figure 1: Atlanto-axial rotational instability. The atlas is shown in the rotated position on the axis. The pivot is the eccentrically placed odontoid process. In rotation, the wall of the vertebral foramen of Cl decreases the opening of the spinal canal between Cl and C2. This can potentially cause migraine headaches, C2 nerve root impingement, dizziness, vertebrobasilar insufficiency, 'drop attacks; neck-tongue syndrome, Barré-Liéou syndrome, severe neck pain, and tinnitus.

Mentions: The upper cervical spine consists of C0, called the occiput, and the first two cervical vertebrae, C1 and C2, or atlas and axis, respectively. C1 and C2 are more specialized than the rest of the cervical vertebrae. C1 is ring-shaped and lacks a vertebral body. C2 has a prominent vertebral body called the odontoid process or dens which acts as a pivot point for the C1 ring [16]. This pivoting motion (Fig. 1), coupled with the lack of intervertebral discs in the upper cervical spine, allows for more movement and rotation of the joint, thus facilitating mobility rather than stability [17]. Collectively, the upper cervical spine is responsible for 50% of total neck flexion and extension at the atlanto-occipital (C0-C1) joint, as well as 50% of total neck rotation that occurs at the atlanto-axial joint (C1-C2) [16]. This motion is possible because the atlas (C1) rotates around the axis (C2) via the dens and the anterior arch of the atlas.


Chronic neck pain: making the connection between capsular ligament laxity and cervical instability.

Steilen D, Hauser R, Woldin B, Sawyer S - Open Orthop J (2014)

Atlanto-axial rotational instability. The atlas is shown in the rotated position on the axis. The pivot is the eccentrically placed odontoid process. In rotation, the wall of the vertebral foramen of Cl decreases the opening of the spinal canal between Cl and C2. This can potentially cause migraine headaches, C2 nerve root impingement, dizziness, vertebrobasilar insufficiency, 'drop attacks; neck-tongue syndrome, Barré-Liéou syndrome, severe neck pain, and tinnitus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4200875&req=5

Figure 1: Atlanto-axial rotational instability. The atlas is shown in the rotated position on the axis. The pivot is the eccentrically placed odontoid process. In rotation, the wall of the vertebral foramen of Cl decreases the opening of the spinal canal between Cl and C2. This can potentially cause migraine headaches, C2 nerve root impingement, dizziness, vertebrobasilar insufficiency, 'drop attacks; neck-tongue syndrome, Barré-Liéou syndrome, severe neck pain, and tinnitus.
Mentions: The upper cervical spine consists of C0, called the occiput, and the first two cervical vertebrae, C1 and C2, or atlas and axis, respectively. C1 and C2 are more specialized than the rest of the cervical vertebrae. C1 is ring-shaped and lacks a vertebral body. C2 has a prominent vertebral body called the odontoid process or dens which acts as a pivot point for the C1 ring [16]. This pivoting motion (Fig. 1), coupled with the lack of intervertebral discs in the upper cervical spine, allows for more movement and rotation of the joint, thus facilitating mobility rather than stability [17]. Collectively, the upper cervical spine is responsible for 50% of total neck flexion and extension at the atlanto-occipital (C0-C1) joint, as well as 50% of total neck rotation that occurs at the atlanto-axial joint (C1-C2) [16]. This motion is possible because the atlas (C1) rotates around the axis (C2) via the dens and the anterior arch of the atlas.

Bottom Line: In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches.In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability.Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate.

View Article: PubMed Central - PubMed

Affiliation: Caring Medical and Rehabilitation Services, S.C., 715 Lake St., Ste. 600, Oak Park, IL 60301, USA.

ABSTRACT
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability.

No MeSH data available.


Related in: MedlinePlus