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Advanced Imaging & Chiropractic

CBCT, Chiropractic, upper cervical

Posterior view of the upper cervical region.

Here is a recent publication from the Journal of Upper Cervical Chiropractic Research by researchers Dr. Jonathan Verderame and Dr. Jake Hollowell. What makes this article impressive is that the patient was evaluated using the cone beam CT (CBCT) technology in a chiropractic setting. This is really unique and, as the article states, “the utilization of CBCT in a clinical chiropractic setting has not been explored.”

While CT is said to be an ‘extremely valuable tool’ that is a ‘widely available noninvasive modality for evaluating abnormalities of the spine’ it has never been used for bio-mechanical assessment of the occipital-atlanto-axial misalignment for chiropractic analysis.

The intervention that was provided to a 75-year-old patient that suffered from chronic migraines was a specialty in chiropractic known as Blair Upper Cervical Technique, or Blair for short. Traditionally this method of chiropractic requires various x-ray images to evaluate the structure and mechanics that are involved in the upper cervical region of the spine. With the CBCT technology, a chiropractor will not only be able to assess the alignment of the vertebrae but also be able to identify small and significant congenital or acquired anomalies that may effect the clinical recommendations of the patient.

CBCT unit by Scanora

CBCT unit by Scanora

This is a fairly new and highly specialized field in chiropractic. The CBCT is more commonly found in a dentist or orthodontist office and used to evaluate structures of the jaw and teeth. While traditional chiropractic care is excellent in caring for migraines and headaches, the research confirmed that the patient only needed two corrections in the 10 week evaluation period.  The use of such equipment in chiropractic specialties has implications that a patient may see greater improvement with less interventions. There is a potential to reach individuals with more complex conditions.

The article address the risk of radiation and states that the CBCT uses “between 98.5% and 76.2% [less radiation] compared to traditional CT.” The way this is done is by “pulsing” the radiation so the patient is not subject to it during the whole procedure. With reduced exposure to radiation and improved image for evaluation, this modality for examining the spine may prove useful in certain cases.

The drawbacks might include the cost to both the practitioner and the patient, specialized training in the use of the imaging software and patient exposure to radiation. As with everything, there’s a risk vs benefit factor.

Read full article

Reference

  • Verderame, Johnathan and Hollowell, Jake. “Cone-beam Computerized Tomography for the Bio-mechanical Assessment of the Occipito-atlanto-axial Articulation in a 75-year-old Woman with Migraines Undergoing Blair Technique” Journal of Upper Cervical Chiropractic Research. July 2013.

Case Study: Chronic Neck Pain

The purpose of this case study is to demonstrate the application of Cone Beam CT (CBCT) scan as an effective imaging method for highly specific upper cervical chiropractic corrections.

Patient History

A 38 year old male presented to the clinic with a chief complaint of neck pain that has persisted for the past 7-8 years. The pain was progressing and becoming intrusive in his desired lifestyle. The patient stated that when the pain is at it’s worst, it radiates into bilateral shoulders and arms.

The precipitating cause is unknown. However the patient did have a MVA 4-5 years prior to the onset of symptoms and has actively participated in soccer for the past 30 years and recalls several times that the symptoms have increased following games where the head was used to deflect the ball.

The patient listed several associated complaints including lightheadedness and loss of equilibrium causing the patient to stop his routine and rest until the spell has past.

The patient also describes headache symptoms of both a tension headache and classic migraine precipitated by alcohol use. Pt states 2 episodes/week. Family history includes similar symptoms of migraine headaches. There is also mid back pain localized to the thoracic/lumbar region that is most notable in the evening.

Patient utilizes pain medication to manage the neck and headache symptoms, which helps but the problem persists.

Chiropractic Exam

Flexion of the neck causes increased pain refereed to the shoulders and arms. There was a negative sharp purser orthopedic test. Left C1 – C4 point tenderness and inflammation nodules were found at the posterior lateral vertebral joints.

The patient had muscle tightness on the left side of the neck as well as multiple muscle spams of the right upper Trapezius and Levator scapulae.

Posture analysis concluded an elevated left head by 2 cm, even shoulders and a high right hip by 1 cm.

Leg length inequality check revealed a 2 cm right short leg with a positive right c2 challenge.

Cervical temperature pattern was established using a Titron thermographic instrument.

Imaging Analysis

Imaging was ordered utilizing a seated 3D CBCT unit. OnDemand3D software was used for the analysis of the images following a variation of the Blair x-ray analysis.

The Foramen Magnum/Spinal Canal study found a large right rotation of axis. This was confirmed on the 3D view. The simulated protracto views found a double posterior misalignment of atlas. An exceptionally “tilted” atlas was found on the posterior 3D view that is also observed on the frontal generated x-ray view.

Care

Upper cervical chiropractic care following the Blair corrective protocol was elected to correct this upper cervical misalignment. Following the first correction and a 20 min rest period the thermographic scan demonstrated a change. The leg length inequality was found to be normal. The patient commented that he felt a bilateral burning sensation in the lower leg region, following the Achilles tendon.

A follow up visit two days later found the burning sensation in the lower legs continued. Cervical thermographic scan and leg length inequality tests were performed and found to negative. This means that the scan was remarkable different from the pattern that was established prior to care and the legs that were found to be uneven before care were found equal after the initial adjustment and continue to be equal 2 days later. The patient also noted a decrease in neck symptoms.

In all, 4 upper cervical adjustments were given in a 3 month period and the patient continued to improve. The patient experiences fewer and less severe episodes of lightheadedness and reports that the tension headaches have become an infrequent occurrence.

Debriefing

Neck pain is a common finding in the population. It is one of the main reasons people seek chiropractic care. Using a CBCT, the chiropractor will have a clearer understanding of the structures involved and be able to screen for anomalies that make some cases particularly difficult.

As with the case above, many times the cause of neck pain is unknown. It is very plausible that the case above was caused or at least exacerbated by the Motor Vehicle Accident sustained a few years earlier. It is also common to find that little traumas, such as deflecting a soccer ball with your head, can complicate and increase the intensity of the existing problem. Identifying and correcting the underlying cause will yield the best result whether that is correcting a bone, changing a habit or modifying the lifestyle.

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