Vertebral subluxation is a pathological condition in which the articulated surfaces of adjacent vertebrae are displaced, preserving the points of contact. Subluxation can be congenital or acquired, traumatic or non-traumatic. It is manifested by pain, pathological muscle tension and restriction of movements. When the nerve roots and spinal cord are compressed, neurological symptoms occur: decreased and loss of sensitivity, muscle weakness and pelvic organ dysfunction. The diagnosis is made on the basis of radiography, MRI and CT. Treatment is more often conservative.
Vertebral subluxation is a partial displacement and/or rotation of one vertebra relative to another. It is the cause of narrowing of the intervertebral canal, can cause the development of pain syndrome, disruption of various organs and systems. Unlike fractures or complete dislocations, they are often not accompanied by vivid clinical symptoms, so patients (especially with non–traumatic subluxations) sometimes do not seek medical help for a long time.
Most often, the subluxation of the vertebra is detected in the more mobile cervical and lumbar spine, the thoracic region is rarely affected. Significant deterioration of the normal functioning of the spine, nerve infringement and blood supply disorders, as a rule, occur with the defeat of the transitional departments – occipital-cervical, cervical-thoracic, thoracic-lumbar and lumbosacral. Treatment of vertebral subluxations is carried out by orthopedic traumatologists and vertebrologists.
Vertebral subluxation causes
Congenital subluxations of the vertebrae occur due to intrauterine developmental abnormalities, as well as during the pathological course of childbirth, when the baby’s head occupies the wrong position during the progress along the birth canal. The cause of acquired subluxation of the vertebra may be trauma (fall, impact, rapid alternation of forced flexion and extension), uncoordinated movement, spastic contraction of paravertebral muscles, benign or malignant tumors, as well as congenital anomalies of the structure of the spine (spondylolysis).
Predisposing factors include heavy physical labor, intensive sports, weight lifting, physical exertion with unheated muscles, prolonged forced body position, hypothermia and diseases that provoke the occurrence of muscle spasms. When there are subluxations of the vertebra in people over 40 years of age, age-related changes in the spine play a significant role.
Vertebral subluxation symptoms
All symptoms of pathology can be divided into nonspecific, arising from damage of any localization, and specific, due to the level of lesion. Non-specific symptoms include pain and muscle tension. If the vertebrae shift suddenly, there is a pronounced pain syndrome, which may be accompanied by a delay in breathing, increased heart rate and profuse sweating. Subsequently, the pain decreases, becomes pulling, intensifying with body turns and muscle tension. In some cases, the acute pain completely disappears, and secondary pulling pains appear only after a while.
Muscle spasm is another constant symptom of vertebral subluxation. Its severity can vary significantly, however, constant excessive muscle tension in all cases plays a negative role, especially with the prolonged existence of subluxation, since spastic muscle contraction contributes to the fixation of the vertebra in the wrong position and aggravates the pathology.
With non-traumatic displacement of the vertebrae (spondylolisthesis), the acute period may be absent. Sometimes there is an asymptomatic course. In some cases, there is discomfort and back pain, which increases with exertion and radiates into the arms or legs, myositis of the parotid muscles, weakness in the extremities, limited mobility of the spine, sensitivity disorders, pelvic organ dysfunction and posture disorders.
Subluxations of the cervical vertebrae often cause compression of the vessels that supply blood to the brain. Due to the deterioration of blood supply, dizziness, headaches, semi-fainting, ringing in the ears, blurred consciousness, attention disorders, memory impairment, chronic fatigue, sleep disorders and a kind of visual impairment (loss of image clarity, defocusing of the gaze) can develop. In some cases, neuritis and neuralgia occur.
The most common subluxations of the cervical vertebrae are rotational subluxation C1, subluxation C1 with the introduction of fragments of the pro-atlant and Kovacs subluxation. Rotational subluxation C1 is a common pathology. It is mainly observed in childhood, occurs with injuries and sharp turns of the head. It is manifested by sharp pain, torticollis, muscle spasm and sharp restriction of movements. Dizziness, headache, “stars” or spots in the eyes are possible. Sometimes spontaneous reduction is observed.
Subluxation C1 with the introduction of fragments of the pro–atlantean is a pathological condition that develops in the presence of a bone anomaly in the form of elements of an additional vertebra (rudimentary parts of the posterior and anterior arch, lateral section or body), lying freely in the ligaments between the atlantean and occipital bone. Such a subluxation causes wedging and functional overload of the atlanto-axial joint with the development of deforming arthrosis. Accompanied by pain and limited mobility of the head. Neurological disorders are possible.
Kovacs subluxation is a condition described by a Hungarian surgeon in the second half of the 19th century. It develops with congenital non-infection of the arch and osteochondrosis of the cervical spine. It is accompanied by the sliding of the articular processes back when bending the neck. When the neck is straightened, the appendages return to the correct position. It can manifest itself with pain and neurological disorders, is a sign of instability of the spine.
With subluxations of the vertebrae of the cervical-thoracic region, compression of the nerves and vessels of the brachial plexus is sometimes observed, accompanied by weakness of the upper limb, numbness and a burning sensation in the fingertips. Subluxations in the thoracic region are characterized by the irradiation of pain along the ribs, in the abdomen or sternum. With the displacement of the lumbar vertebrae, long-term persistent radiculitis or lumbago is observed. There may be numbness, a feeling of heaviness and a feeling of “torsion” in the lower extremities. In some cases, twisting pains are localized in the groin area or lower abdomen.
To clarify the localization, nature and severity of the displacement, radiography of the spine is performed using standard and additional projections. If pathological disc changes are suspected (disc protrusion, intervertebral hernia), an MRI of the spine is prescribed. In the presence of neurological disorders, the patient is referred to a neurologist for consultation. Electromyography is used to assess the functional state of peripheral nerves. If there is a suspicion of a violation of the blood supply to the brain, rheoencephalography is performed.
Vertebral subluxation treatment
Treatment is carried out by specialists in the field of traumatology and orthopedics, vertebrology and neurology, depends on the cause, prescription, level and nature of the displacement. With fresh traumatic subluxations, simultaneous reduction or extension is performed using a Glisson loop. Then a trench collar or plaster cast is applied, physiotherapy, physical therapy and massage are prescribed. With recurrent and irreparable traumatic subluxations, interbody fusion is indicated.
With long-standing and non-traumatic dislocations of the vertebrae, measures to eliminate the pain syndrome and strengthen the paravertebral muscles come to the fore. In acute pain, it is recommended to limit physical activity and use a special corset. With chronic pain without signs of compression of nerve roots, physiotherapy and exercise therapy are prescribed. If necessary, drug therapy is carried out to relieve pain and eliminate muscle spasm.
The indication for surgical intervention is the ineffectiveness of conservative treatment, pronounced compression of nerve structures and progressive displacement of one vertebra relative to another. The operation is performed in order to stabilize the affected segment, prevent further “sliding” of the vertebra, as well as eliminate and prevent possible neurological disorders.
Depending on the nature, level and severity of the pathology, transpedicular fixation, interbody fusion, plate fixation or a combination of these methods can be used. If necessary, a laminectomy is performed. With signs of compression of nerve structures, the vertebral canal is revised and decompression of the spinal cord and nerve roots is performed. Restoration of the anatomical correspondence of the location of the vertebrae is not always carried out, since the active elimination of displacement can lead to nerve damage with the development of neurological symptoms.