Analysis of three-dimensional facet joint displacement during two passive upper cervical mobilizations

Siccardi, Davide; Buzzatti, Luca; Marini, Michele; Cattrysse, Erik

doi:10.1016/j.msksp.2020.102218

Cited by 5 publications

(8 citation statements)

References 36 publications

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“…These values can be influenced by coupled motions 32–34,44,45 and can also be present when treating patients. Manually actuated cervical spine specimens have been examined in previous studies 21,45,46 . From a clinical point of view, the ability of the practitioner to manually feel the physiological ROM in our study added more value to the results.…”

Section: Discussionmentioning

confidence: 93%

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Intersegmental Kinematics of the Upper Cervical Spine

Lorente

Hidalgo-García

Rodríguez-Sanz

et al. 2021

Spine

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Study Design. Biomechanical study using cadaveric cervical spines. Objective. To evaluate joint mobility and stiffness at the craniovertebral junction. Summary of Background Data. Data on the intersegmental kinematics of the craniovertebral joints are available in the literature with a widespread range of values. The effect that alar ligament injuries have on intersegmental kinematics remains unclear and requires further biomechanical investigation. Methods. Ten occipito-atlanto-axial (C0-C1-C2) human specimens were articulated to flexion, extension, bilateral lateral bending, and bilateral axial rotation. The moment-rotation response was continuously tracked through the entire range of motion before and after unilateral alar ligament transection of the right side.Results. The intersegmental (C0-C1/C1-C2) moment-rotation response was continuously quantified in full flexion (7.2 AE 6.68/ 12.1 AE 5.88), extension (11.1 AE 6.48/3.0 AE 2.88), lateral bending to the right (3.1 AE 2.28/1.6 AE 1.28) and left sides (3.3 AE 1.68/ 2.1 AE 1.58), and axial rotation to the right (1.2 AE 3.58/32.3 AE 9.38) and left sides (2.7 AE 2.68/25.3 AE 8.38). Unilateral alar ligament transection increased the range of motion of C0-C2 in the three planes of movement; however, intersegmental motion alterations were not always observed. Conclusion. Increases in the range of extension and lateral bending at C0-C1, which had not been reported previously, were observed. Further, the range of rotation on the right and left sides increased, in conjunction with the increased ranges at C0-C1 and C1-C2.

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Section: Discussionmentioning

confidence: 93%

“…In the three segments, the x-axis pointed forward; the y-axis was defined positive to the left; and the z-axis completed a right hand-oriented coordinate system pointing upward. In this protocol, flexion, right lateral bending, and left axial rotation were defined as positive and the opposite motions as negative 2,20,21 …”

Section: Methodsmentioning

confidence: 99%

Intersegmental Kinematics of the Upper Cervical Spine

Lorente

Hidalgo-García

Rodríguez-Sanz

et al. 2021

Spine

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“…Cadaver studies have previously been used to quantify both normal AO joint functionality and AO joint instability [ 49 , 50 ]. It may be possible to refashion a cadaveric AO joint to match the flattening found in CMI patients and examine the impact on stability and the supporting muscles and ligaments.…”

Section: Discussionmentioning

confidence: 99%

A new hypothesis for the pathophysiology of symptomatic adult Chiari malformation Type I

Labuda¹,

Nwotchouang

Ibrahimy

et al. 2022

Medical Hypotheses

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Chiari malformation Type I (CMI) is characterized by herniation of the cerebellar tonsils through the foramen magnum. The pathophysiology of CMI is not well elucidated; however, the prevailing theory focuses on the underdevelopment of the posterior cranial fossa which results in tonsillar herniation. Symptoms are believed to be due to the herniation causing resistance to the natural flow of cerebrospinal fluid (CSF) and exerting a mass effect on nearby neural tissue. However, asymptomatic cases vastly outnumber symptomatic ones and it is not known why some people become symptomatic. Recently, it has been proposed that CMI symptoms are primarily due to instability of either the atlanto-axial (AA) or the atlanto-occipital (AO) joint and the cerebellar tonsils herniate to prevent mechanical pinching. However, only a small percentage of patients exhibit clinical instability and these theories do not account for asymptomatic herniations. We propose that the pathophysiology of adult CMI involves a combination of craniocervical abnormalities which leads to tonsillar herniation and reduced compliance of the cervical spinal canal. Specifically, abnormal AO and/or AA joint morphology leads to chronic cervical instability, often subclinical, in a large portion of CMI patients. This in turn causes overwork of the suboccipital muscles as they try to compensate for the instability. Over time, the repeated, involuntary activation of these muscles leads to mechanical overload of the myodural bridge complex, altering the mechanical properties of the dura it merges with. As a result, the dura becomes stiffer, reducing the overall compliance of the cervical region. This lower compliance, combined with CSF resistance at the same level, leads to intracranial pressure peaks during the cardiac cycle (pulse pressure) that are amplified during activities such as coughing, sneezing, and physical exertion. This increase in pulse pressure reduces the compliance of the cervical subarachnoid space which increases the CSF wave speed in the spinal canal, and further increases pulse pressure in a feedback loop. Finally, the abnormal pressure environment induces greater neural tissue motion and strain, causing microstructural damage to the cerebellum, brainstem, and cervical spinal cord, and leading to symptoms. This hypothesis explains how the combination of craniocervical bony abnormalities, anatomic CSF restriction, and reduced compliance leads to symptoms in adult CMI.

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“…Whether or not there are sufficient differences in joint morphology between individuals to allow differentiation has not yet been demonstrated, though some degree of motion range has been reported in literature for the atlanto‐occipital joint (Chancey et al, 2007 ; Siccardi et al, 2020 ). Indeed, the articular surfaces of this joint have a large (important) inter‐ and intra‐individual variation as proven by several studies.…”

Section: Discussionmentioning

confidence: 99%

An osteometric and 3D analysis of the atlanto‐occipital joint: An initial screening method to exclude crania and atlases in commingled remains

Cappella

Affatato

Gibelli

et al. 2021

American Journal of Biological Anthropology

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Objectives: The anatomical features of the atlanto-occipital joint can be potentially useful in re-associating or excluding crania to atlases in commingled remains. This study investigated whether linear measurements and the 3-dimensional (3D) surface of occipital condyles and articular facets of atlases can represent valid insights for this purpose. Methods:The variations among eight corresponding linear distances were analyzed in a sample of 150 individuals through six supervised machine learning techniques attempting to develop classifiers able to identify elements belonging to the same individual. Furthermore, a 3D analysis was conducted on the articular surfaces through superimpositions of 3D models of corresponding and non-corresponding crania and atlases obtained by using respectively stereophotogrammetry and laser scanning. This analysis investigated differences in terms of point-to-point distances (Root Mean Square, RMS) of superimposed 3D surfaces.Results: None of the six machine learning techniques were able to correctly detect a satisfying percentage of correspondent pairs in the overall sample by using the linear variables. The 3D analysis of the articular surfaces found RMS values over 0.53 mm only for superimposed non-corresponding surfaces, which sets a threshold value to identify 32% of incorrect pairs. Discussion: The re-association of cranium to atlas proved to be challenging and hardly possible when considering only metric variables. However, the 3D geometry of the articular surfaces represents a valid variable for this purpose and 3D analyses pave the way for an initial exclusion of incorrect re-associations, thus should not be considered as a re-association method per se, but as an exclusionary screening technique.

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Analysis of three-dimensional facet joint displacement during two passive upper cervical mobilizations

Cited by 5 publications

References 36 publications

Intersegmental Kinematics of the Upper Cervical Spine

Intersegmental Kinematics of the Upper Cervical Spine

A new hypothesis for the pathophysiology of symptomatic adult Chiari malformation Type I

An osteometric and 3D analysis of the atlanto‐occipital joint: An initial screening method to exclude crania and atlases in commingled remains

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