Pathophysiological Mechanisms and Clinical Implications of Upper Cervical Vertebral Subluxations (Neurological Disorders with Craniocervical Dysfunction)
Jonathan Verderame 1 , M. Shakib Arslan 2*
Biosensors and Nanotheranostics 3(1) 1-8 https://doi.org/10.25163/biosensors.319795
Submitted: 11 January 2024 Revised: 17 March 2024 Published: 20 March 2024
Abstract
Background: The craniocervical junction is a critical neuro-anatomical region, playing a significant role in health and disease due to its vulnerability. Upper cervical vertebral subluxations, defined as alterations in the atlanto-axial motion and/or position relative to the cranium and cervical spine, can disrupt normal physiological processes. This article aims to provide a comprehensive overview of the fundamental science, clinical models, and pathophysiology related to upper cervical vertebral subluxation. Methods: This review article synthesizes existing literature on upper cervical vertebral subluxation. It examines various models and mechanisms, including subluxation degeneration, the subluxation complex model, compression of the brainstem and neural structures, dysafferentation, the neurodystrophic model, and segmental facilitation. Neurobiological mechanisms such as dyskinesia, dysgenesis, dysautonomia, dysafferentation, neuroplasticity, and ephaptic transmission are also explored. Results: The review identifies and interprets multiple neurobiological mechanisms associated with upper cervical vertebral subluxations. Each model and mechanism highlights the potential impact on neurophysiology and overall health. The article discusses how these subluxations can lead to various systemic consequences, providing evidence from both fundamental science and clinical perspectives. Conclusion: Upper cervical vertebral subluxations have significant implications for health due to their potential to interfere with normal physiology through various neurobiological mechanisms. Understanding these mechanisms and their clinical relevance can enhance diagnostic and therapeutic approaches, ultimately improving patient outcomes. Further research is needed to deepen our understanding of these complex interactions and their broader implications for health and disease.
Keywords: Craniocervical junction, Vertebral subluxation, Neurobiological mechanisms, Chiropractic care, Cervical spine alignment, Atlanta axial joint, segmental dysfunction
References
Bakris, G., Dickholtz, M., Meyer, P. M., Kravitz, G., Avery, E., Miller, M., ... & Bell, B. (2007). Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: A pilot study. Journal of Human Hypertension, 21(5), 347-352.
Boal, R. W. (1986). The concept of subluxation: A brief history and some current perspectives. Journal of Manipulative and Physiological Therapeutics, 9(2), 89-91.
Bolton, P. S., & Holland, C. T. (1996). Afferent signaling of vertebral displacement in the neck of the cat. Society for Neuroscience Abstracts, 22, 1802.
Bolton, P. S., & Holland, C. T. (1998). An in vivo method for studying afferent fibre activity from cervical paravertebral tissue during vertebral motion in anaesthetised cats. Journal of Neuroscience Methods, 85(2), 211-218.
Bor-Seng-Shu, E., Kita, W. S., Figueiredo, E. G., Paiva, W. S., Fonoff, E. T., Teixeira, M. J., & Panerai, R. B. (2012). Cerebral hemodynamics: Concepts of clinical importance. Arquivos de Neuro-Psiquiatria, 70, 357-365.
Budgell, B., & Polus, B. (2006). The effects of thoracic manipulation on heart rate variability: A controlled crossover trial. Journal of Manipulative and Physiological Therapeutics, 29(8), 603-610.
Bulut, M. D., Alpayci, M., Senköy, E., Bora, A., Yazmalar, L., Yavuz, A., & Gülsen, I. (2016). Decreased vertebral artery hemodynamics in patients with loss of cervical lordosis. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 22, 495.
Ding, J. Y., Zhou, D., Pan, L. Q., Ya, J. Y., Liu, C., Yan, F., ... & Meng, R. (2020). Cervical spondylotic internal jugular venous compression syndrome. CNS Neuroscience & Therapeutics, 26(1), 47-54.
Dishman, R. (1985). Review of the literature supporting a scientific basis for the chiropractic subluxation complex. Journal of Manipulative and Physiological Therapeutics, 8(3), 163-174.
Evans, D. W. (2002). Mechanisms and effects of spinal high-velocity, low-amplitude thrust manipulation: Previous theories. Journal of Manipulative and Physiological Therapeutics, 25(4), 251-262.
Fiester, P., Rao, D., Soule, E., Orallo, P., & Rahmathulla, G. (2021). Anatomic, functional, and radiographic review of the ligaments of the craniocervical junction. Journal of Craniovertebral Junction and Spine, 12(1), 4-9.
Flanagan, M. F. (2015). The role of the craniocervical junction in craniospinal hydrodynamics and neurodegenerative conditions. Neurology Research International, 2015.
Gatterman, M. I. (2005). Foundations of Chiropractic: Subluxation. Elsevier Health Sciences.
Gay, C. W., Robinson, M. E., George, S. Z., Perlstein, W. M., & Bishop, M. D. (2014). Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain. Journal of Manipulative and Physiological Therapeutics, 37(9), 614-627.
González, D. C. N., Ardura Aragón, F., Sanjuan, J. C., Maniega, S. S., Andrino, A. L., García Fraile, R., ... & Córdova-Martínez, A. (2022). C1-C2 rotatory subluxation in adults: A narrative review. Diagnostics, 12(7), 1615.
Haavik, H., & Murphy, B. (2010). Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. Journal of Manipulative and Physiological Therapeutics, 33(9), 643-651.
Haavik, H., & Murphy, B. (2012). The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. Journal of Electromyography and Kinesiology, 22(5), 768-776.
Haavik, H., & Murphy, B. (2012). The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. Journal of Electromyography and Kinesiology, 22(5), 768-776.
Haavik-Taylor, H., & Murphy, B. (2007). Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study. Clinical Neurophysiology, 118(2), 391-402.
Harrison, D. E., Cailliet, R., Harrison, D. D., Janik, T. J., & Holland, B. (2002). Changes in sagittal lumbar configuration with a new method of extension traction: Nonrandomized clinical controlled trial. Archives of Physical Medicine and Rehabilitation, 83(11), 1585-1591.
Harrison, D. E., Cailliet, R., Harrison, D. D., Troyanovich, S. J., & Harrison, S. O. (1999). A review of biomechanics of the central nervous system—Part III: Spinal cord stresses from postural loads and their neurologic effects. Journal of Manipulative and Physiological Therapeutics, 22(6), 399-410.
Harrison, D. E., Haas, J. W., Cailliet, R., Harrison, D. D., Holland, B., & Janik, T. J. (2005). Concurrent changes in lumbar lordosis and the cervical curvature in patients with cervical kyphosis or the lack of cervical lordosis: A non-randomized, retrospective clinical study. Archives of Physical Medicine and Rehabilitation, 86(12), 2305-2312.
Harrison, D. E., Haas, J. W., Cailliet, R., Harrison, D. D., Holland, B., & Janik, T. J. (2005). Concurrent changes in cervical lordosis and lumbar curvature with opposite cervical configurations: A non-randomized, retrospective clinical study. Archives of Physical Medicine and Rehabilitation, 86(11), 2287-2292.
Hart, J. (2016). Analysis and adjustment of vertebral subluxation as a separate and distinct identity for the chiropractic profession: A commentary. Journal of Chiropractic Humanities, 23(1), 46-52.
Henderson, C. N. (2005). Three neurophysiologic theories on the chiropractic subluxation. In Foundations of Chiropractic: Subluxation (pp. 296-303). St. Louis: Elsevier Mosby.
Huber, M., van Vliet, M., Giezenberg, M., Winkens, B., Heerkens, Y., Dagnelie, P. C., & Knottnerus, J. A. (2016). Towards a ‘patient-centred’ operationalisation of the new dynamic concept of health: A mixed methods study. BMJ Open, 6(1), e010091.
Kang, J. (2023). Patient-specific hemodynamic modeling of cerebral blood flow: 1-D mathematical model. University of California, Los Angeles.
Katz, E. A., Katz, S. B., Fedorchuk, C. A., Lightstone, D. F., Banach, C. J., & Podoll, J. D. (2019). Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis. Brain Circulation, 5(1), 19-26.
Kent, C. (1996). Models of vertebral subluxation: A review. Journal of Vertebral Subluxation Research, 1(1).
Kent, C. (2017). Heart rate variability to assess the changes in autonomic nervous system function associated with vertebral subluxation. Research Reviews in Neuroscience, 1, 14-21.
Kent, C. (2018). Chiropractic and mental health: History and review of putative neurobiological mechanisms. Journal of Neuropsychiatry and Brain Research, JNPB-103.
Kent, C. (2019). Proposed neurobiological processes associated with models of vertebral subluxation: Dysafferentation, dyskinesia, dysponesis, dysautonomia, neuroplasticity and ephaptic transmission. Archives of Neurology & Neuroscience, 3(1).
Kiani, A. K., Maltese, P. E., Dautaj, A., Paolacci, S., Kurti, D., Picotti, P. M., & Bertelli, M. (2020). Neurobiological basis of chiropractic manipulative treatment of the spine in the care of major depression. Acta Bio Medica: Atenei Parmensis, 91(Suppl 13).
Kwon, C., Binongo, J. N., McCoy, M., & Binongo, J. (2023). Secondary analysis of a dataset to estimate the prevalence of vertebral subluxation and its implications for health promotion and prevention. Cureus, 15(11).
Lantz, C. A. (1995). The vertebral subluxation complex. In Foundations of Chiropractic: Subluxation (pp. 149-174).
Lantz, C. A. (1995). The vertebral subluxation complex. In Foundations of Chiropractic: Subluxation (pp. 149-174).
Lelic, D., Niazi, I. K., Holt, K., Jochumsen, M., Dremstrup, K., Yielder, P., & Haavik, H. (2016). Manipulation of dysfunctional spinal joints affects sensorimotor integration in the prefrontal cortex: A brain source localization study. Neural Plasticity, 2016.
McPartland, J. M., & Brodeur, R. R. (1999). Rectus capitis posterior minor: A small but important suboccipital muscle. Journal of Bodywork and Movement Therapies, 3(1), 30-35.
Melzack, R., & Wall, P. D. (1996). The challenge of pain (2nd ed.). Penguin Books.
Moustafa, I. M. (2013). Does improvement towards a normal cervical sagittal configuration aid in the management of fibromyalgia: A randomized controlled trial. Bulletin of the Faculty of Physical Therapy Cairo University, 18(2), 29-41.
Moustafa, I. M., Diab, A. A. M., Hegazy, F. A., & Harrison, D. E. (2017). Does rehabilitation of cervical lordosis influence sagittal cervical spine flexion-extension kinematics in cervical spondylotic radiculopathy subjects? Journal of Back and Musculoskeletal Rehabilitation, 30(4), 937-941.
Moustafa, I. M., Diab, A. A., & Harrison, D. E. (2017). The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: A 1-year randomized controlled study. European Journal of Physical and Rehabilitation Medicine, 53(1), 57-71.
Moustafa, I. M., Diab, A. A., & Harrison, D. E. (2017). The effect of normalizing the sagittal cervical configuration on dizziness, neck pain, and cervicocephalic kinesthetic sensibility: A 1-year randomized controlled study. European Journal of Physical and Rehabilitation Medicine, 53(1), 57-71.
Moustafa, I. M., Diab, A. A., & Harrison, D. E. (2022). The efficacy of cervical lordosis rehabilitation for nerve root function and pain in cervical spondylotic radiculopathy: A randomized trial with 2-year follow-up. Journal of Clinical Medicine, 11(21), 6515.
Moustafa, I. M., Diab, A. A., Hegazy, F., & Harrison, D. E. (2018). Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: A 1-year randomized controlled trial. BMC Musculoskeletal Disorders, 19, 1-13.
Moustafa, I. M., Diab, A. A., Hegazy, F., & Harrison, D. E. (2021). Demonstration of central conduction time and neuroplastic changes after cervical lordosis rehabilitation in asymptomatic subjects: A randomized, placebo-controlled trial. Scientific Reports, 11(1), 1-10.
Moustafa, I. M., Diab, A. A., Taha, S., & Harrison, D. E. (2016). Addition of a sagittal cervical posture corrective orthotic device to a multimodal rehabilitation program improves short-and long-term outcomes in patients with discogenic cervical radiculopathy. Archives of Physical Medicine and Rehabilitation, 97(12), 2034-2044.
Moustafa, I., Youssef, A. S., Ahbouch, A., & Harrison, D. (2021). Demonstration of autonomic nervous function and cervical sensorimotor control after cervical lordosis rehabilitation: A randomized controlled trial. Journal of Athletic Training, 56(4), 427-436.
Murphy, B. A., Dawson, N. J., & Slack, J. R. (1995). Sacroiliac joint manipulation decreases the H-reflex. Electromyography and Clinical Neurophysiology, 35(2), 87-94.
Murphy, B. A., Dawson, N. J., & Slack, J. R. (1995). Sacroiliac joint manipulation decreases the H-reflex. Electromyography and Clinical Neurophysiology, 35(2), 87-94.
Murphy, D. R. (2010). Letter to the editor: Mechanisms of spinal manipulation: Key issues and current evidence. Journal of Electromyography and Kinesiology, 20(6), 912-914.
Nelson, C. (1997). The subluxation question. Journal of Chiropractic Humanities, 7, 46-55.
Pickar, J. G. (2002). Neurophysiological effects of spinal manipulation. Spine Journal, 2(5), 357-371.
Ravindra, V. M., Neil, J. A., Mazur, M. D., Park, M. S., Couldwell, W. T., & Taussky, P. (2015). Motion-related vascular abnormalities at the craniocervical junction: Illustrative case series and literature review. Neurosurgical Focus, 38(4), E6.
Rectenwald, R. J., DeSimone, C. M., & Sweat, R. W. (2018). Vascular ultrasound measurements after atlas orthogonal chiropractic care in a patient with bow hunter syndrome. Journal of Chiropractic Medicine, 17(4), 231-236.
Rome, P. L. (1996). Usage of chiropractic terminology in the literature: 296 ways to say “subluxation”: Complex issues of the vertebral subluxation. Chiropractic Technique, 8(2), 49-60.
Rosa, S., & Baird, J. W. (2015). The craniocervical junction: Observations regarding the relationship between misalignment, obstruction of cerebrospinal fluid flow, cerebellar tonsillar ectopia, and image-guided correction. In The Craniocervical Syndrome and MRI (pp. 48-66). Karger Publishers.
Rosa, S., Baird, J. W., Harshfield, D., & Chehrenama, M. (2018). Craniocervical junction syndrome: Anatomy of the craniocervical and atlantoaxial junctions and the effect of misalignment on cerebrospinal fluid flow. In Hydrocephalus-Water on the Brain (pp. 27-39). IntechOpen.
Russell, D. (2019). The assessment and correction of vertebral subluxation is central to chiropractic practice: Is there a gap in the clinical evidence? Journal of Contemporary Chiropractic, 2, 4-17.
Sampath, K. K., Mani, R., Cotter, J. D., & Tumilty, S. (2015). Measureable changes in the neuro-endocrinal mechanism following spinal manipulation. Medical Hypotheses, 85(6), 819-824.
Senzon, S. A. (2018). The chiropractic vertebral subluxation part 1: Introduction. Journal of Chiropractic Humanities, 25, 10-21.
Seoane, E., & Rhoton Jr, A. L. (1999). Compression of the internal jugular vein by the transverse process of the atlas as the cause of cerebellar hemorrhage after supratentorial craniotomy. Surgical Neurology, 51(5), 500-505.
Stinear, C. M. (2003). Manipulation-induced changes in corticospinal excitability. Manual Therapy, 8(3), 145-150.
Triano, J. J. (2001). Biomechanics of spinal manipulative therapy. Spine Journal, 1(2), 121-130.
Valera-Calero, A., Gallego-Izquierdo, T., Malfliet, A., & Pecos-Martín, D. (2019). Endocrine response after cervical manipulation and mobilization in people with chronic mechanical neck pain: A randomized controlled trial. European Journal of Physical and Rehabilitation Medicine, 55(6), 792-805.
Vernon, H. (2010). Historical overview and update on subluxation theories. Journal of Chiropractic Humanities, 17(1), 22-32.
Vernon, H. (2010). Historical overview and update on subluxation theories. Journal of Chiropractic Humanities, 17(1), 22-32.
Win, N. N., Jorgensen, A. M. S., Chen, Y. S., & Haneline, M. T. (2015). Effects of upper and lower cervical spinal manipulative therapy on blood pressure and heart rate variability in volunteers and patients with neck pain: A randomized controlled, cross-over, preliminary study. Journal of Chiropractic Medicine, 14(1), 1-9.
Zhang, J., Dean, D., Nosco, D., Strathopulos, D., & Floros, M. (2006). Effect of chiropractic care on heart rate variability and pain in a multisite clinical study. Journal of Manipulative and Physiological Therapeutics, 29(4), 267-274.
Zhu, Y., Haldeman, S., Hsieh, C. Y. J., Wu, P., & Starr, A. (2000). Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores? Journal of Manipulative and Physiological Therapeutics, 23(7), 458-464.
Zhu, Y., Haldeman, S., Starr, A., Seffinger, M. A., & Su, S. H. (1993). Paraspinal muscle evoked cerebral potentials in patients with unilateral low back pain. Spine, 18(8), 1096-1102.
View Dimensions
View Altmetric
Save
Citation
View
Share