Unstable cervical vertebrae treatment. Treatment of cervical spine instability

Nowadays, a fairly common pathology is instability of the cervical spine, the symptoms and treatment of which can only be determined by your attending physician. The phenomenon is quite common, but unpleasant, characterized by excess mobility between two or more vertebrae. Such violations can radically affect a person’s life and change it not in the best way. But, if the disease is identified at an early stage of development, correctly diagnosed and prescribed adequate treatment, the situation can be corrected.

The cervical region provides a certain number of vertebrae, which are assigned the functions of mobility and stability. Due to this, a person can easily tilt his head in any direction, bending and unbending his neck. This is what mobility is all about, thanks to the stability between the vertebrae, balance is maintained, so they are completely protected from deformation. Instability of the cervical spine develops after injury or osteochondrosis against the background of increased mobility.

Due to the disturbed distance between adjacent vertebrae, the amplitude increases, thus causing instability, which often manifests itself along with displacement. To determine the disease, the doctor only needs to understand that the vertebrae have moved forward by 4 mm.

Medicine distinguishes between several types of disease, taking into account the circumstances that caused disorders above the spine in the neck area.

Degenerative. A form that develops after osteochondrosis, due to the destruction of disc tissue and the fibrous ring. Degenerative-dystrophic changes lead to the fact that the retaining and supporting functions weaken.
Post-traumatic. Instability in the cervical spine resulting from injury; in children this can be postpartum trauma, which is common.
Postoperative. A form of spinal disease that worries the patient after surgery. This indicates that during the operation the condition of the supporting elements of the spine was damaged.
Dysplastic vertebral instability. According to medical definitions, dysplasia is a general term that means abnormal development. Disturbances can affect tissues or the body as a whole, changing the size, shape or structure of the cell. As for dysplastic instability in the cervical spine, in this case we are talking about joints and intervertebral ligaments, as well as discs or the body itself. In most cases, this form of the disease develops against the background of dysplastic syndrome.

Symptoms

As a rule, instability of the cervical vertebrae is characterized by the following symptoms:

pain in the neck, which will increase during physical activity;
pain with slight turns of the neck;
the tone of the muscle mass increases, thus causing rapid fatigue and overexertion;
after some time, the neck muscles weaken and pain is felt even during palpation;
during compression of the vessels of the spinal cord, the patient has a headache, dizziness and surges in blood pressure;
some more complex cases are accompanied by disorders associated with sensitivity, weakness in the limbs, and sometimes the development of complete or partial paralysis can be observed.

A large list of symptoms complicates local diagnosis, so patients are often misdiagnosed. Most often, doctors rely on signs of pain and discomfort in the neck above the spine and prescribe treatment based on the information received. This is explained by the fact that the vertebrae are displaced and compress the nerve endings of the spinal cord, in addition, the spinal bed narrows. The pain is so severe that the patient looks for a comfortable position in which he will be comfortable, and tries to hold his head that way. But this position cannot be natural; as a result, the neck muscles quickly get tired, blood circulation in the area of the neck is disrupted, and soon they cannot withstand even a small load throughout the day.

The most important indicator is the displacement of the vertebrae in the neck, a fairly serious disorder that requires treatment. In order to make an accurate diagnosis, the doctor needs an x-ray, but a vertebral displacement of 4 mm is already considered instability.

Treatment

Therapy involves two main methods: pills or surgery, if the situation is really bad. Instability of the cervical spine, the symptoms and treatment of which depend on the individual characteristics of the patient’s body, responds well to conservative therapy, according to qualified specialists. Surgery is not required, since medications help to obtain good results in treatment, but there are also indicators that indicate that surgery is necessary.

The conservative technique involves:

Using a special head holder, there are two kinds, soft and hard.
Experts recommend novocaine blockades if pain in the neck intensifies.
Non-steroidal anti-inflammatory drugs are prescribed.
Physiotherapy is prescribed.
Therapeutic complex massage, but cupping, acupuncture or acupressure is allowed.
Reflexology is carried out on the basis of acupuncture or cryotherapy.
Possibility of treatment with physical exercises.
Spinal traction.

Surgical intervention is necessary in case of instability of the cervical spine in particularly difficult situations, when not only the spine itself is affected, but also the internal organs. There are certain indications for the operation:

Subluxation appeared against the background of instability.
Weakening of the disease in a short period of time or the manifestation of frequent exacerbations.
Individual intolerance of the patient, as a rule, occurs as a result of one of the methods of conservative treatment.
Persistence of signs of instability due to more serious diseases. For example, a disc herniation or compression of a nerve ending.

During the operation, the surgeon fixes the vertebrae using a special plate; it prevents their displacement in the future, but at the same time, maintains mobility. As a rule, the plate is fixed on the side of the back; after a certain period of time, the graft can dissolve or a joint is formed in its place, which is medically called a false joint.

Instability in the cervical spine is a fairly serious problem, a pathology that needs to be studied from all sides. In addition, it is important to correctly diagnose and prescribe effective, timely treatment. Preventive measures and comprehensive rehabilitation measures help to avoid the most complex disorders; they preserve the patient’s ability to work and ensure a high quality of life.

What is cervical spine instability? We will discuss the causes, diagnosis and treatment methods in the article by Dr. Nikitin S.S., a neurologist with 10 years of experience.

Definition of disease. Causes of the disease

The musculoskeletal system contains joints that are naturally immobile, that is, stable. This property can be lost, then the joints and joints become “unstable”. For example, the symphysis pubis or sacroiliac joints may lose their immobility after childbirth or due to injuries to this anatomical area. Segments of the spine also refer to formations that can lose their immobility, which is what is called in medical practice by the term "instability". It is worth noting that in children under 10 years of age, instability is considered normal, since the structures responsible for the stability of the spine are in a phase of active growth at their age.

The adult spine consists of 33 or 34 vertebrae (there is a normal variant with six lumbar vertebrae), which amounts to 25 or 26 motion segments.

Spinal segment is the anatomical and functional unit of the spine. Anatomically, the segment consists of the intervertebral disc, the lower half of the overlying vertebra, the upper half of the underlying vertebra, the anterior and posterior longitudinal ligaments, the ligamentum flavum, the intervertebral joints, as well as all the soft and nervous tissues located at this level.

The following structures (listed in descending order) are responsible for the stability of the segment: intervertebral disc, ligaments and facet joints, vertebral bodies.

Accordingly, the reasons for the development of instability affect precisely the listed structures.

The reasons are:

birth injuries, sports injuries, road injuries, etc. (ligaments, discs and vertebral bodies);
disc degeneration (protrusion and hernia);
surgical interventions on the spine (discs, ligaments and facets);
developmental anomalies of the spine and its structures (any structure).

Symptoms of cervical spine instability

Disc displacement as a manifestation of segment instability may not always give rise to any symptoms and complaints. Instability that causes specific symptoms is called “clinically significant.”

1. Pain. This also includes headaches. It is the most common symptom and occurs periodically. Often appears after physical activity, often already during exercise. It also occurs after sleeping in an uncomfortable position, prolonged sitting with the head tilted forward and down, and also when bending and straightening the head. When you turn your head to the sides and there is instability, numbness of the limbs and dizziness may occur. It also often appears when performing incorrectly selected exercises that are not suitable for the patient, or when performing them incorrectly.

2. Muscle symptoms. Constant feeling of tension in the neck muscles, fatigue. Everyday stress causes tension, pain and requires rest.

3. Focal neurological symptoms. In its manifestations it resembles radicular symptoms - shooting pains, numbness and weakness of the upper extremities. When palpating the paravertebral points, pain is detected.

4. Hypertension syndrome. It manifests itself as an increase in intracranial pressure, which, in turn, increases headaches and dizziness. It is also manifested by an increase in blood pressure. Many authors believe that both of these manifestations are fraught with the development of panic attacks.

5. Vestibulo-cochlear and oculo-cochlear disorders. These include tinnitus and dizziness, blurred vision. Patients often turn to ophthalmologists or otolaryngologists, but examination of the organs of vision and hearing does not reveal any significant disorders. Symptoms are caused by compression of the vertebral artery, which is possible with changes in the height of the intervertebral discs and spondyloarthrosis, or arthrosis of the intervertebral joints.

6. Spinal deformity. The pain is relieved by keeping the neck fixed, often by bending to the side. Prolonged stay in this position changes the shape of the neck, causing the formation or strengthening of kyphosis (curvature of the spine in the shape of a hump). By the way, that same growth that many call “fat accumulation” can be a symptom of instability.

7. Sleep disturbance. Develops when pain becomes chronic. A constant feeling of discomfort, the inability to find a comfortable position for sleeping, a forced posture when performing everyday activities - all this contributes to neuroticism, and, as a result, sleep disturbance develops.

Pathogenesis of cervical spine instability

The issue of studying the pathogenesis of instability of segments of the cervical spine was studied by Krismer and his students. They experimentally proved that the fibers of the fibrous ring of the intervertebral disc limit the rotation of the vertebrae even more than the intervertebral and facet joints. They also listed various definitions of instability, describing it as consisting of the following mechanical anomalies:

excessive forward movement in the dorsolateral direction, which is the result of destruction of the disc and disruption of its structure;
pathological synkinesis (or double movement), which develops as the next stage when the disc is unable to perform its stabilizing function and transfer the center of gravity to adjacent vertebrae + discs + ligaments;
an increase in the neutral zone, which is the result of the previous stage. Any movement is pathological and affects many vertebrae.
pathological center of rotation (movement around the longitudinal axis). In a situation of gradual disc destruction, which is observed with disc protrusions and herniations, the intervertebral joints take on the function of limiting rotation. For these joints, this function is excessive, and arthrosis develops in them. This is how degenerative (or discogenic) instability progresses. The result is the development of spondyloarthrosis (degenerative disease of the intervertebral joints).

The development of other types of instability is currently controversial. Although, considering the pathogenesis of postoperative instability, many authors agree that the operation itself is a factor that increases instability. After all, it is difficult to imagine a situation where it was necessary to remove a healthy disk.

Classification and stages of development of instability of the cervical spine

There are three stages of instability:

First stage. Develops between the ages of 2 and 20 years. At this stage, acute pain localized near the spine or radicular pain may be bothersome. Radiologically it is often not detected.
Second stage. Develops between the ages of 20-60 years. At this stage, frequent recurrent pain that occurs in the intervertebral joints and/or ligaments is disturbing. Radiologically, along with signs of instability, spondyloarthrosis of varying degrees and a decrease in the height of the discs are determined.
Third stage. Develops after 60 years. At this stage, the mobility of the intervertebral joints is significantly reduced, which helps stabilize the spine. This causes a decrease in the frequency and intensity of pain. It should be remembered that the pain syndrome can be quite intense with the development of reactive systemic diseases.

Complications of cervical spine instability

The most common complications are compression of the vertebral artery (or vertebral artery syndrome) and intense pain.

Vertebral artery syndrome develops in two situations:

when the artery is compressed in the intervertebral spaces by osteophytes during the development of spondyloarthrosis;
at the extravertebral level with the inferior oblique muscle.

Compression of the artery is fraught with the development of cerebral and vestibular symptoms in the form of headache, dizziness and noise effects. With acute compression, as a rule, an acute attack develops in the form of severe dizziness with nausea and vomiting, and impaired vestibular function. With prolonged compression, a chronic disorder of cerebral and spinal circulation develops.

A disorder of motor function and sensitivity develops when the muscles and nerves located in the intermuscular spaces are compressed. Characterized by limited muscle function and numbness in the area of nerve innervation.

The most serious complications of instability include spinal stenosis And spinal cord compression.

Both disorders are dangerous due to circulatory disorders, a sign of which is damage to the conducting nerve fibers, which is clinically manifested by paresis (paralysis) of the upper and lower extremities, dysfunction of the pelvic organs and skin sensitivity.

To be fair, it is worth noting that such complications occur extremely rarely with the current level of diagnosis and treatment.

Diagnosis of cervical spine instability

Collection of complaints and medical history is an integral stage of patient examination. In this case, the doctor pays attention to the characteristics and descriptions of the pain syndrome, its localization, accompanying symptoms, such as headache, dizziness, unsteadiness when walking, etc.

Neurological examination. During the examination, the neurologist determines the pain of paravertebral points in the cervical spine, muscle tension and soreness, areas of reflected and radiating pain, sensitivity disorders, range of movements of muscles and joints, range of movements in the cervical spine.

X-ray examination. In standard projections, signs of instability are rarely found. It is mandatory to perform functional x-ray studies. This is the most important technique, which has unfortunately been neglected lately. When performed, the anteroposterior displacement of the body of one vertebra relative to another vertebra is determined. The generally accepted thickness of this size is 4 mm. One possible reason why the technique is increasingly being ignored is the fact that there is no correlation between the severity of symptoms and the size of the displacement.

CT scan used to study the entire cervical spine or one vertebra. A CT scan of the cervical spine can determine the width of the spinal canal and the degree of spondyloarthrosis.

Magnetic resonance imaging used to examine the entire cervical spine, allowing for a particularly thorough examination of the intervertebral discs.

Treatment of cervical spine instability

If instability is present, treatment should be comprehensive. Prevention plays a huge role.

Treatment consists of several stages.

Drug treatment:

non-steroidal anti-inflammatory drugs are intended to relieve inflammation, reduce and cure pain;
muscle relaxants help reduce muscle spasm and tone, help reduce compression of the nerve roots;
B vitamins nourish nervous tissue, restoring and protecting it;
D vitamins and calcium supplements are prescribed to patients with osteoporosis.

Physiotherapeutic treatment.

It is an effective means of treating pain, relieving inflammation, restoring nerve and muscle tissue. Physiotherapeutic treatment also allows you to deliver a medicinal substance to the lesion using an electric current. In physiotherapeutic treatment the following is used:

techniques that relieve inflammation: electrophoresis, magnetic therapy, UHF therapy;
techniques that promote tissue regeneration: laser therapy, mud therapy.

It is a method of relieving acute pain by delivering a medicinal substance directly to its source. It is carried out by a neurologist in a medical institution (not at home!) after a special training course. The medicinal substance can be a solution of Novocaine 0.5% or a solution of Lidocaine 2%. You can also add solutions of vitamins or hormones. The composition of the administered substance is selected by the doctor in accordance with clinical indications in the absence of contraindications to the administered drugs. It should be noted that a neurologist should not inject the substance into the intervertebral joints; this procedure can only be performed by neurosurgeons.

Spinal immobilization.

It is one of the first remedies for exacerbation. It is carried out with a special collar that limits mobility. It is prescribed only by a doctor and is selected strictly individually according to the size of the neck. It is recommended that the selection be carried out in specialized orthopedic salons. The mode of wearing a collar is also recommended depending on the cause of the exacerbation.

It is a means of mobilizing the vertebrae. It is forbidden to perform during the acute period of injury. Performed by a chiropractor on the recommendation of a neurologist after examination.

It is one of the most effective means of prevention and treatment. The course is developed for the patient depending on the cause of instability, as well as the condition of the spine. The goal of gymnastics is to strengthen muscle tissue (ligaments and muscles). If gymnastics is carried out after an injury or surgery, it is carried out only under the supervision of a neurologist or instructor-methodologist in the exercise therapy room. After training, the course is carried out at home independently.

Reflexology, in particular acupuncture.

It is a means of relieving pain, restoring muscle and nervous tissue, treating associated symptoms: improving blood circulation, improving sleep. It is performed only by a reflexologist using special needles.

Surgery.

Is a rare practice. Performed in childhood in case of proven structural anomalies. In adult practice, spinal fusion is more often performed. It consists of implanting a structure made of metal plates and fixing elements. Its task is to prevent excessive mobility of the spine. The operation is used after injuries, discotomies and laminectomies. The last two are performed for spinal hernias.

Forecast. Prevention

Bibliography

1. Kremer Jurgen. Diseases of the intervertebral discs. Per. from English; under general ed. prof. V.A. Shirokova. – M.: MEDpress-inform, 2013. – 472 p.: ill.
2. Travell and Simons. Myofascial Pain and Dysfunction: A Guide to Trigger Points. In 2 volumes. T.1. // Simons D.G., Travell J.G., Simons L.S.: Trans. from English – 2nd ed., revised and expanded. – M.: Medicine, 2005. – 1192 p.: ill.
3. Levit K., Zahse J., Yanda V. Manual medicine. Per. with him. I.I. Skvortsova. – M.: Medicine, 1993. – 456 p.: ill.
4. Mumentaler Marco. Differential diagnosis in neurology. Guide to the assessment, classification and differential diagnosis of neurological symptoms / Marco Mumenthaler, Claudio Basseti, Christoph Detwiler; lane with him. – 3rd ed. – M.: MEDpress-inform, 2012. – 360 pp.: ill.
5. Popelyansky Ya.Yu. Orthopedic neurology (vertebroneurology): a guide for doctors / Ya.Yu. Popelyansky. – 5th ed. – M.: MEDpress-inform, 2011. – 672 p.: ill.

The cervical spine includes seven vertebrae. Of the entire spine, it is the most mobile, which explains the possibility of turns, movements or tilts of the head.

The vertebral arteries pass through the processes of the vertebrae, which have openings. It is thanks to them that the brain is fully nourished with important substances, oxygen and microelements.

If there are any damage or inflammatory processes that may affect the cervical vertebrae, the ability to fully supply will cease.

Such diseases are very dangerous, so you need to monitor your neck health more carefully.

General information about pathology

The occurrence of excessive mobility in the spine suggests the development of cervical instability. A similar situation can occur in case of displacement, excessive range of motion of the vertebrae, or too free a degree of motion.

Early detection of the disease is complicated by the absence of pain, and instability itself is often diagnosed only through an x-ray.

Mobility and stability

The spine of every person includes these properties. Stability is necessary to maintain the relationship between the discs and vertebrae, which prevents their deformation, and also prevents the possible development of pain during any physical activity.

This criterion as a whole will depend on the stability of individual elements of the spine.

Such a criterion as the mobility of the spine will be more individual, since everything here depends on the structure of the vertebrae, on the size of the disc between them, as well as on some other factors. The cervical section is considered the most mobile.

Reasons that provoke instability

The reasons that could cause the development of instability in the cervical spine may be the following:

Injury. It can be either mechanical or resulting from an accident;
Congenital feature;
Osteocondritis of the spine;
Surgical intervention.

One of the causes of instability may be myositis of the cervical muscles. You can learn how to identify the disease from our article. In what cases it is recommended to prescribe an MRI of the lumbosacral spine and what diseases it can detect can be found here.

Symptoms of the disease

Cervical spine instability has the following most common symptoms:

Pain. May increase significantly after physical activity;
Deformation of the spine, which may even be visible from the outside;
Limitations in the ability to move the neck;
Feelings of tension in the muscles of the cervical region.

Classification

Functional instability of the cervical spine may be of the following types:

Diagnostic techniques

Diagnosis of instability in the cervical spine is made through interviews, x-rays, and some neurological findings.

X-ray manifestations

The instability becomes especially noticeable on the radiograph. Most often, two photographs are taken, in the first of which the person’s head is in an upright position, and in the second it is bent forward.

In the first case, the deflection is noticeable more than usual. In the second, the spine also bends, but outward. In some cases, displacement of the odontoid process also becomes noticeable, since the jaw bone does not overlap it.

Neurological manifestations

With instability of the spine, a noticeable narrowing of the vertebral canal occurs, as a result of which the following symptoms may appear. They can be grouped into three conditional categories:

Radicular. This includes symptoms such as radiculitis, lumbago, cervicalgia;
Spinal. Paresis, twitching, weakness or numbness of the limbs;
Neurodystrophic. In this case, a muscle is damaged, weakness becomes pronounced, and periarthritis and cardinal syndrome may occur.

Treatment of pathology

Treatment measures for instability of the cervical spine can be divided into methods that do not include surgical treatment methods and, in fact, surgical intervention.

Conservative treatment

This type of impact on the disease is the most acceptable. Usually there is no need to resort to complex surgical intervention, since conservative treatment gives excellent results.

In general, the effect on the cervical spine is not particularly different from other methods of treating diseases associated with the spine.

There is a special list of measures that will help cope with the disease:

Surgical intervention

Surgical intervention for instability of the cervical spine is necessary only in particularly serious cases, when the disease has begun to affect not only the spine, but also the functioning of the internal organs.

Surgery is indicated in the following cases:

The appearance of subluxation due to instability;
Short period of remission and frequent exacerbations;
Individual intolerance, which may arise from some conservative treatment methods;
Persistent symptoms that may be caused by more serious problems. These include, for example, disc herniation, compression of nerve fibers, and more.

The cervical vertebra is usually fixed using a special plate, which prevents further displacement, but at the same time allows its mobility to be maintained.

When performing posterior spinal fusion surgery, the plate is usually secured from the back. It is important to note that the graft may be reabsorbed or a joint called a false joint may appear.

Set of exercises

During the period of treatment of instability, wearing a special collar is necessary, but during this period the mobility of the cervical spine decreases significantly, and the muscles, without sufficient training, weaken.

In case of instability of the cervical spine, special exercises are needed more than ever that will restore all functions and also further strengthen the joints.

It is best to perform the complex under the supervision of a specialist, but you can choose exercises that can be easily performed at home:

The first exercise is performed using, for example, a rubber bandage. It should be folded in several layers, and then one side should be fixed to the wall. You need to insert your head into the second resulting hole and leave the elastic band at forehead level. It is necessary to sit upright, while making leisurely deviations to the side and forward.
Turns the head to the sides. If at the same time the neck crunches slightly, then it’s okay. But if the pain is severe and the crunch is very obvious, then this is a clear reason to seek additional advice.
The head roll is an exercise in which the chin is pressed to the chest and gradually rolls over it. It is not recommended to tilt your head back too much. Trainers advise trying to “stretch” the top of your head up, while stretching your neck, and only slightly tilt your head back.
The hand spread is not performed particularly intensively. A slow pace is most acceptable. Hands should be placed on the belt, shoulders raised up, and then pulled back. In this case, you should try to touch with your elbows. Of course, this cannot be done, but after the exercise you feel lightness in the joints of both the neck and scapular area.

Video: Neurologist talks about spinal instability

Cervical spine instability and its treatment

Despite its rare occurrence, instability of the cervical spine is a rather painful problem for society. This is due to the fact that its elimination is very difficult. In most cases, a sick person is left alone with such a pathology, especially when deciding issues of treatment tactics. After all, none of the specialists can guarantee the success of upcoming health activities. Therefore, before making a decision when choosing a treatment method, it is so important to become as familiar as possible with the effectiveness and consequences of each of them.

Step one: understanding the essence of the problem and identifying it

Normally, the mobility of the cervical segments of the spine is very high. It is caused by the summation of small volumes of displacement of each vertebra relative to each other. If neighboring vertebrae violate the permissible limits of mutual position, this does not increase the motor activity of the neck and head, but reduces it. Violation of the stability of the spine in the cervical region is nothing more than its inability to perform habitual and sometimes vital movements. This is due to dislocations, subluxations, and displacements of the vertebrae caused by the failure of the musculo-ligamentous and articular-disc apparatus, which is designed to ensure normal mobility and stability of the cervical vertebrae. In this case, symptoms such as severe neck pain, deformation with impaired mobility of the head and neck appear. The most important criterion for establishing a diagnosis is the transient nature of these symptoms. They arise suddenly as the structural elements of the cervical spine overcome a certain type of load.

The correct diagnosis is not always easy to establish, which becomes the reason for unsuccessful treatment. This is due to the existence of hidden forms of spinal instability in the cervical region. They can proceed atypically, acquiring a mask of various diseases (vertebral artery syndrome, myelopathy, dyscalgia, etc.) In this case, nonspecific symptoms arise: headaches, dizziness, impaired coordination of movements, tension in the cervical muscles, numbness of the back of the head and neck. Even instrumental diagnostic methods are not always sufficiently informative. Therefore, the diagnosis should be determined taking into account the smallest details and subtleties that the patient must bring to the attention of the doctor.

X-rays of the cervical spine in different positions are the main method for diagnosing its instability.

Step two: determining the type of stability disorder and treatment tactics

In relation to the choice of treatment tactics, instability of the cervical spine can be considered from different perspectives:

Instability in the form of periodic pathological (excessive) mobility of the vertebrae, which is independently eliminated after the cessation of the action of the provoking factor. There are no pronounced structural changes or deformations of the spinal column. There is only pain in the neck area of varying severity. In such patients, there is a weakening of hard and soft tissue structures (ligaments, muscles, articular cartilage and discs). The reasons for their occurrence must be clarified, and treatment is aimed at eliminating provoking factors and strengthening weakened elements (exercises, massage).
Instability in the cervical spine in the form of a violation of the normal anatomical relationships between the vertebrae, which cannot be eliminated on its own. In this case, a pronounced pain syndrome occurs in combination with deformation, dislocation, subluxation of the vertebrae visible during examination, on x-rays or tomograms. The very fact that they are not eliminated on their own indicates deep structural changes in the spinal segment. Therefore, treatment should be aimed at correcting disrupted anatomical relationships between the vertebrae and preventing their reoccurrence.
Instability of the cervical spine, which is persistent. In this case, there is a local or general curvature of the vertebral axis. It intensifies during exercise and is accompanied by mild pain. Most of all, such stability disorders are reflected in the form of a sharp limitation in the mobility of the head and neck. Such patients require forceful manual or surgical correction methods.
A combination of any kind of instability of the cervical spine with osteochondrosis and herniated intervertebral discs. Such patients require a differentiated approach to treatment with determination of the prevailing disease. For large intervertebral hernias, regardless of the type of instability, surgical treatment is recommended. In all other cases, the selection of treatment should depend on the type of instability.

Important to remember! The less time the instability of the cervical spine exists, the more acute pain and minimal deformation it manifests itself. The long-term existence of this pathological condition has the opposite symptoms!

Step three: strict implementation of all points of the treatment program

Treatment of spinal instability in the cervical region is represented by the following methods:

immobilization of the vertebrae using a special collar;
maintaining a gentle motor regimen;
balanced diet;
drug treatment;
performing novocaine blockades;
massage and manual therapy;
strengthening exercises and comprehensive physical therapy;
physiotherapeutic procedures;
surgery.

Neck immobilization

Achieved by using collars of a hard or soft design. The choice of product is made by a specialist, taking into account the type of instability. The point of immobilization is to provide additional strengthening to the weakened spinal segment. In this way, functional stability is achieved. A hard collar limits the movement of the neck to a greater extent than a soft one. It is used for a limited time in severe forms of instability and in the postoperative period.

The use of a fixation collar is one of the key points in the treatment of spinal stability disorders

Compliance with motor mode

Movements in the cervical spine should be limited. Sharp turns and tilts of the head, axial load on the neck, which lead to pain and displacement of the vertebrae, are excluded. Patients should remember this, especially in the early period after achieving positive dynamics during treatment. On the other hand, complete exclusion of motor activity for a long time leads to atrophy of the musculo-ligamentous and osteo-articular apparatus of the spine. Therefore, movements must be comparable to the actual capabilities of the spine.

Balanced diet

One of the important elements of the treatment program. The cause of instability in many cases is degenerative processes in bone and connective tissue due to insufficient supply of nutrients (osteoporosis, osteochondrosis, muscular dystrophy, etc.) Therefore, patients’ diets include foods containing high concentrations of calcium and other microelements, vitamins, protein (vegetables, fruits, nuts, berries, dairy products, meat dishes, eggs).

Drug therapy

Treatment with medication for instability of the cervical spine is purely symptomatic. The drugs used from the group of painkillers and anti-inflammatory drugs (naklofen, ketanov, analgin, movalis, etc.) have only a temporary effect. They are indicated in the presence of persistent pain. If there is muscle spasm in the neck, muscle relaxants (mydocalm, sirdalud) are used. Many patients are indicated for long-term use of chondroprotectors - drugs for strengthening intervertebral joints (structum, teraflex, chondroitin complex, etc.)

Novocaine blockades

Local injection of local anesthetics (longocaine, novocaine, lidocaine) into pain points in the neck for vertebral instability is indicated in rare cases. The indication may be severe pain or muscle spasm that cannot be relieved by taking painkillers. For osteochondrosis and spinal deformities, blockades are used, including an anesthetic with a steroidal anti-inflammatory drug (kenalog, hydrocortisone, diprospan).

Massage and manual therapy

Some of the key methods for treating instability. With the help of massage, the muscles and ligaments of the spine are strengthened. Manual techniques can eliminate acute subluxations of the cervical vertebrae and relieve muscle spasms.

Important to remember! Instability of the cervical vertebrae requires long-term treatment. In most cases, its basis is proper physical activity, exercise therapy, massage and physiotherapy. Only by strengthening weakened muscular and ligamentous paravertebral structures can vertebral stability be created!

Physiotherapy

It is best to select exercises from the exercise therapy complex with a specialist. The main principle that must be observed is a gradual increase in the volume and strength of the movements performed. The exercises are simple and can be performed several times a day. If positive results are achieved, you can perform them with the help of additional devices (rubber bandage). Exercises can be like this:

bending the head with simultaneous pressure on the forehead with both hands, creating counteraction;
extension of the head with simultaneous counteraction with the hands on the occipital region;
lateral tilts of the head with counteraction with the hands on the corresponding temporal area;
rotational turns of the head with counteraction with the hands alternately in both directions;
starting position standing with slight retraction and simultaneous extension of the neck backwards. In this position, by bending the neck, the chin is pulled towards the sternum (their direct contact is not necessary).

Correctly selected exercises are the key to successful treatment of instability of the cervical vertebrae

The exercises are performed 8-10 times each with a delay in muscle tension for 5-7 seconds. If necessary, their number and execution time can increase or decrease.

Physiotherapy

It is an addition to exercise therapy and massage. Methods of electrophoresis, myostimulation, magnetic therapy, and water procedures are used. By increasing blood flow in the muscles, they are strengthened, spasm and pain are reduced.

Surgical treatment

It is used either in the presence of severe deformity with persistent vertebral instability, or in the absence of effect from conservative measures. It consists of artificially creating stability by fixing adjacent vertebrae with a metal plate (spinal fusion).

Treatment of spinal stability disorders in the cervical spine is a multi-stage, sequential and lengthy process. The more timely it is started, the better its results.

Cervical spine instability

Instability refers to certain physiological changes in the structure of any part of the spine, in which the variability of the displacement of its constituent vertebrae in one direction or another exceeds 3 mm. The location of the source of the disease seriously affects the chosen treatment and medical recommendations.

The cervical segment of the spine is more susceptible to such changes than others due to the structural features of the vertebrae, facet joints and intervertebral discs - the main components responsible for instability of the cervical spine.

Most often, the disease occurs in older people and adolescent children, which is understandable from the point of view of the natural susceptibility of the cervical spine to processes associated with age-related changes.

Neck instability: classification according to causes

Among the most likely factors that provoke instability of the cervical vertebrae, doctors highlight:

Mechanical damage (injuries are considered the most common cause of disruption of the physiological relationship between the vertebrae of this part of the spine);
Chronic degenerative processes occurring in the articular apparatus (slightly less often, instability of the cervical spine causes advanced osteochondrosis);
Negative consequences of surgery (postoperative complications or improper implementation of the intervention can also affect the occurrence of hypermobility);
Congenital anomalies (most rarely, such changes appear as a result of congenital spinal dysplasia).

Symptoms and clinical picture of instability of the cervical vertebrae

Most often, patients consult a doctor with a set of specific complaints; these signs are the characteristic features that make it possible to diagnose spinal instability in the neck area. Therefore, it is extremely important to pay attention to the following symptoms:

pain in the neck;
frequent migraines;
dizziness;
uncomfortable head position, difficulty finding a relaxing sleeping position.

A list that includes only these symptoms is more common in children than in adults. Middle-aged people, in addition to the listed symptoms, also experience many other manifestations of the disease:

pain that is irritative in nature (penetrating pain when instability of the cervical spine involves nerves and their endings, which can lead to unpleasant sensations in the arms, lower back and legs);
spinal column deformities (physical displacement of the vertebrae or discs between them);
changes in the number of physiological movements of the cervical vertebrae (both a decrease and an increase in mobility are considered pathological);
instability of the vertebrae of the neck that occurs after physical activity or excessive stress (especially important for children going through a period of active growth);
increased muscle tone, spastic syndrome (expressed by increasing fatigue of the muscles of this part of the spine).

In addition to the standard manifestations of the clinical picture of the disease, neck hypermobility also has neurological symptoms:

Shooting or other manifestations of radicular syndrome;
A noticeable decrease in the strength of the neck muscles, a decrease in the mobility of the joint, which is directly related to the affected muscle;
Numbness, twitching, and paresis are caused by compression of the spinal cord.

Methods for diagnosing cervical hypermobility

Accurate diagnosis and adequate treatment require taking into account not only the symptoms of the disease, but also the results of numerous studies. Standard diagnostic methods that can differentiate spinal instability in the neck from other diseases include:

high-quality history taking;
Examination of the patient, palpation of the neck;
X-rays at rest and at maximum flexion;
Standard laboratory tests.

Often, X-ray images are only sufficient to diagnose simple forms of the disease.

Magnetic resonance imaging is an alternative method for detecting the disease in adults and children with complications.

In case of urgent need, a special contrast composition can be used.

Therapy for neck vertebral instability

Instability of the spine in each of its segments has different treatment, however, it is preferable to treat the disease in any department using conservative therapy methods. Surgical intervention is a last resort and must have serious justification.

Drug treatment

Conservative treatment is especially effective in adults and children, when the disease is in its initial stage and has few clinical manifestations. The patient's medical history should not contain serious limitations, and the patient himself should not experience pain. Standard methods of therapy consist of strict adherence to the doctor’s recommendations and the procedure for following treatment procedures.

Establishing a gentle regime, reducing stress on the neck.
Proper organization of sleep: orthopedic pillow and mattress.
Clear tracking of body position and gait.
Visiting the office of a massage therapist or chiropractor.
Undergoing physiotherapeutic procedures (electrophoresis in combination with a local anesthetic is especially effective in eliminating spinal instability in the neck area).
Taking anti-inflammatory drugs.
Pain therapy.
Wearing a neck brace.
Performing a complex of therapeutic exercises.

The last two items on the list require additional clarification and special attention from both the doctor and the patient.

A neck corset, indicated for wearing when there is hypermobility of the neck, can be hard or soft. The general long-term wearing of the head holder is regulated only by a specialist, based on the basic treatment. The soft Shants collar promotes long-term unloading of the muscles, providing average fixation of the cervical vertebrae. The Philadelphia head holder is considered a stiffer tire, which is indicated for a serious stage of the disease. The disadvantage of this corset is the increasing possibility of atrophy of the muscles of this part of the spinal column;
Therapeutic gymnastics requires extreme care, since instability of the cervical spine causes increased susceptibility of the vertebrae to injury, dislocation and displacement. It is optimal to start classes in a special class, under the guidance of a trainer. Subsequently, many exercises can be performed at home on your own, following the course of treatment and recovery.

Putting the cervical vertebrae in place is a rather lengthy process. However, conservative treatment of instability is also preferable because all its components have a minimum of contraindications and side effects. This makes such therapy possible not only for adults, but also for children.

Surgical intervention

Nevertheless, there are a number of signs that determine immediate surgical intervention, among them are:

ineffective treatment of this part of the spine with conservative methods for more than three months;
subluxation caused by vertebral instability;
individual intolerance to components, medications or procedures important for therapy;
clear compression of the nerve endings of the cervical vertebrae.

Surgical treatment of neck vertebrae is a complex process. Artificial stability is achieved by inserting a bone graft into the space between unstable vertebrae, a method called surgical spondylosis. There is an option of anterior or posterior implantation; the first, in turn, is more preferable and has less chance of postoperative complications and implant rejection. However, there are particularly complex cases of the disease when double insertion is required to ensure the most reliable fixation of this part of the spine.

Instability of the cervical vertebrae is equally common in both adults and children, and the disease itself is not as dangerous as its accompanying symptoms or possible consequences. Often a standard set of conservative therapy is sufficient to completely eliminate the negative impact of instability on the patient’s life. A positive result is achieved if the doctor prescribes the correct treatment and the patient follows all the specialist’s recommendations.

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Instability of the cervical spine in adults, children: symptoms, how to treat

Damage to the nerve roots causes pain and loss of function of the organs they innervate. The pain is felt in the neck and radiates to the crown, back of the head, scapula, and shoulder girdle. Numbness and weakness appear in certain areas of the shoulder girdle and arm.

Acute compression of the root causes lumbago - a one-sided sharp muscle spasm. Severe pain is accompanied by severe muscle tension, the head takes a forced position.

Obstruction of blood flow through the vertebral arteries impairs the nutrition of the posterior parts of the brain (vertebral artery syndrome). Therefore, there is a connection between instability of the cervical spine and dizziness, which occurs when turning the head and is accompanied by headaches and other symptoms.

Since turning and tilting the head worsens health, a person spares the affected area, reducing the range of movements.

Upon examination, it may be revealed

stigma of connective tissue dysplasia,
unevenness of the line of the spinous processes during movements in the neck,
restriction of active movements (gentle load mode) with functional blockades and muscle tension,
vertebral artery syndrome.

Features in childhood

Children have greater neck mobility than adults. This is due to anatomical age-related features and a large percentage of cartilage tissue. With ossification (ossification) of ligaments and cartilage, mobility decreases.

In infants, instability of the cervical spine is most often a consequence of birth injuries, but dysplasia is also possible. Muscle tone in the limbs and torso changes, possible development of torticollis (muscular-tonic syndrome), restless sleep, regurgitation, autonomic disorders. The child prefers to keep his head turned to one side and sleeps better on this side.

Instability of the cervical spine can lead to obstruction of venous outflow from the skull, which is manifested by increased intracranial pressure. The consequence of this is delayed psychomotor development and neurological symptoms.

Consequences and complications

Systematic microdamages with instability lead to degeneration. Irreversible changes occur:

with deformation and permanent displacement of the vertebrae,
disk destruction,
spondyloarthrosis,
osteochondrosis.

Compression of the spinal cord or disruption of its blood circulation are the most dangerous complications of instability of the cervical spine. A spinal syndrome occurs with damage to different pathways. In this case, peripheral paralysis of the limbs (paraplegia, tetraplegia), sensory disturbances, and pelvic disorders are possible.

Damage to the nerve roots leads to atrophic processes in the muscles of the neck, shoulder girdle, arm and scapula area.

Severe vertebral artery syndrome causes ischemia of the posterior parts of the brain and brainstem, and a stroke is possible in these areas. Cephalgia and impaired coordination of movements become constant, sleep deteriorates.

Diagnostics

History taking and examination are complemented by examinations. Diagnosis is based on the detection of pathological displacement of the vertebrae during movements.

The main method is radiography with functional tests and special installations. Initial signs can be detected by a radiologist if the patient is in good health. This happens in the first stage, when muscle strength still holds the vertebrae.
Ultrasound is also more informative when conducting tests, visualizing changes in soft tissues and blood vessels. Widely used in children.
MRI of the cervical spine allows you to see structural changes in all tissues, identifying anomalies in the structure and position of all formations. But instability is not determined, since changes during movements are not recorded.

How to treat

When treating instability, conservative methods aimed at compensating the condition are preferred. The operation is indicated for a progressive course with the development of compression of nerve structures and blood vessels, ineffectiveness of the treatment and persistence of symptoms.

Conservative treatment of cervical spine instability is:

prevention,
neck fixation during exacerbation of the condition and physiotherapy.

Medicines are prescribed to reduce pain and relieve neurological symptoms. It is possible to take non-steroidal anti-inflammatory drugs, B vitamins, neurotrophic drugs, novocaine in the form of blockades.

You can't rotate your head,
movements in the neck with resistance and twisting.
Self-extensions are not allowed.

It is possible to carry out massage using a special technique, courses of manual therapy (against the background of regular muscle-strengthening exercises), physiotherapy (magnetic therapy, electrophoresis).

In case of instability of the cervical spine, it is advisable to carry out training in exercise therapy techniques under the supervision of an instructor. The exercises are aimed at forming a muscular corset to support the vertebrae. They should not cause pain, be sharp, with a load or at the limit of possible amplitude.

To limit movements, exercises are performed on a special simulator. At home, it can be replaced with a wide elastic bandage, folded in a loop and fixed to the wall at the level of the forehead of a sitting person. Having put a stretched support loop on your forehead, you need to slowly tilt your head alternately in all directions up to 20 times. Then, turning around and putting the loop on the back of your head, perform the next series of bends.

Pathology manifests itself during movements. But the progression of the process can cause irreversible changes and serious consequences.

The anatomical structure of each joint determines the range of movements that a person can perform. The main role in this physiological limitation is played by: the shape of the articular surfaces, the ligamentous apparatus (intra- and extra-articular), and the muscular corset. Damage to these structures can lead to excessive joint mobility under axial loads. Instability of the cervical vertebrae is the most dangerous process, as it can lead to severe neurological symptoms.

Instability and hypermobility

In clinical practice, two terms are used that refer to movement disorders in the joint. To understand what it is: instability of the cervical vertebrae c3 and c4 (or another level of the cervical spine), it is necessary to accurately define these concepts. Instability of the spinal segment is the inability of a separate part of the spinal column to withstand the load without the appearance of signs of pathology (local pain, limitation of movements, and so on). The severity of symptoms will depend on the degree of instability and the strength of physical activity.

In contrast to the term described above, hypermobility refers to the pathological mobility of articular surfaces on a radiograph. We can say that this is a diagnostic sign of instability. It is determined using functional positions - maximum flexion and extension. In each of them, a photograph of the patient’s spine is taken in a lateral projection. The displacement of the vertebrae relative to each other is assessed, deviations from the median axis during flexion/extension are compared, and the pathological focus is identified.

It should be noted that segment instability can occur without hypermobility. The converse is also true.

Causes of instability

In the journal "Vertebrology", four options for segment instability are given, depending on the reason for its formation:

post-traumatic - occurs after the action of significant physical force on a certain part of the spine. 70% of all injuries that result in instability are caused by motor vehicle accidents or sports. A smaller percentage consists of compression injuries after a fall. A separate group of post-traumatic instabilities consists of birth injuries of the cervical spine in newborns;
dysplastic – disturbances in the synthesis of the structures of the facet (intervertebral) joints cause this group of instability. As a rule, the onset of pathology occurs in adolescence. Professor A.N. Demchenko notes in such patients the underdevelopment of the ligamentous apparatus of the spine and the fibrous ring of the intervertebral discs;
degenerative - this group is a frequent companion to osteochondrosis of stages II-IV. Its formation is based on impaired blood supply to the intervertebral discs and abnormal synthesis of cartilage tissue, which leads to the gradual destruction of the affected segment of the spine;
postoperative - such instability occurs after radical interventions on the vertebra. Most often, according to the journal "Vertebrology", this is a laminectomy (removal of a segment of the vertebral arch above the spinal root). There is a violation of the integrity of the posterior supporting complex of the spine, which can lead to mobility of the vertebra.

Of all the causes, 76% are post-traumatic group. The clinical picture of instability of the cervical vertebrae does not differ significantly with different development mechanisms.

Symptoms of cervical instability

As a rule, the disease begins typically - with pain in the neck, which is caused by constant tension in the muscles that hold the vertebra in its place. In the early stages, it is of medium or low intensity and can be purely discomforting. Rarely radiates to adjacent parts of the body. Pain increases after prolonged flexion/extension of the cervical spine or physical activity.

The clinical recommendations of traumatologists note that the initial period of pathology in 45% is accompanied by neck deformity. The severity of the physiological anterior bend (cervical lordosis) decreases and becomes smoothed. This is a transient disorder - over time it can disappear or significantly worsen, which in 96% of cases is accompanied by neurological symptoms.

Without adequate treatment, symptoms of cervical instability begin to intensify. There are two syndromes that can be combined with each other in different ways:

vertebral-radicular conflict – occurs when there is pressure on the spinal roots. Almost always accompanied by degenerative instability. Often symptoms are observed on only one side. It is characterized by acute pain with “shooting”, which radiates to the upper extremities. There may be loss of sensation in a limited area of the arm or neck. Paresis/paralysis in one muscle or its portion is possible (depending on the level of damage). Compression of the roots is accompanied by paresthesia (a feeling of “crawling or tingling);
vertebromedullary conflict - compression of the spinal cord with instability of the cervical vertebrae C3 or C4 (and above) leads to severe neurological disorders in the form of paresis/paralysis, loss of sensitivity below the level of damage. With bilateral compression, the patient is unable to control the acts of urination and defecation (retention alternates with incontinence).

To prevent the development of such a clinical picture, it is necessary to promptly consult a doctor who will determine treatment tactics.

Treatment of cervical vertebrae instability

Currently, in the treatment of instability of the cervical vertebrae, preference is given to conservative treatment methods, which are aimed at strengthening the ligamentous apparatus of the damaged vertebra. For this purpose, the following set of measures is carried out:

eliminating physical stress on the cervical spine;
neck fixation using a Shants collar;
To relieve pain, nonsteroidal therapy is used intramuscularly or orally: Ketorolac, Ibuprofen, Citramon, and so on. If necessary, it is possible to use blockades;
physiotherapy aimed at improving blood supply to the cervical spine (warming, galvanization, electrical stimulation according to Gerasimov).

If treatment for instability of the cervical vertebrae is ineffective, surgical intervention is indicated - spinal fusion (fixation of the vertebra). It is necessary to distance it as much as possible, since the operation is crippling in nature.

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Anatomical and functional features of the cervical spine

The cervical spine consists of seven vertebrae and is the most mobile. The first cervical vertebra has a special structure and name - atlas (C1). This vertebra lacks a body and an intervertebral disc. The atlas consists of two arches (anterior and posterior), which act as a limiter for the lumen of the spinal canal and are connected to each other by lateral bone thickenings. On the upper surface of the atlas there are concave articular elements - processes connecting to the condyles of the occipital bone.

The next, second cervical vertebra is called epistropheus or axis (C2). It has a vertebral body continuous with the odontoid process and no intervertebral disc. The odontoid process protrudes upward, connects with the inner surface of the anterior arch of the atlas and forms a joint. The atlas and axis are connected by three joints: two lateral and one middle. When these three joints are combined, a compound joint is formed, which allows for rotational movements of the head. The other five vertebrae have a vertebral body that performs a supporting function. These vertebrae are separated by intervertebral discs, which act as shock absorbers of the spinal column. The vertebrae are surrounded by ligaments, muscles, nerves and blood vessels.

Stability and mobility of the cervical spine

This part of the spine has contradictory properties of mobility (mobility) and stability. Mobility refers to the ability to perform various types of movements (flexion, extension, lateral bending, circular movements) with the head.

Stability is understood as the ability of the spine, under physiological loads, to maintain relationships between the vertebrae, protecting it from deformation and various pain sensations. The stability of the spine directly depends on the stability of its individual segments.

A vertebral segment is usually called two adjacent (located next to each other) vertebrae, which are connected to each other by an intervertebral disc.

Spinal instability (SP).

Instability refers to functional deviations and pathological (abnormal) mobility in the spinal segment. These include: the emergence of new degrees of freedom of movement, an increase in the amplitude of movements. Vertebral displacement is one of the main indicators of NP.

Types of NP:

- post-traumatic - instability appeared after a spinal injury (fracture, dislocation of the vertebrae).

Degenerative - develops against the background of ongoing degenerative-dystrophic processes in the spine (for example, with osteochondrosis).

Postoperative - develops as a result of a violation of the integrity of the supporting structures of the spine, occurring, as a rule, after surgery, more often after lamyectomy (an operation aimed at stopping compression of the spinal cord, as well as one or more nerve roots).

Dysplastic - appears against the background of improper formation (change in size, structure, shape) of the vertebral body, spinal ligaments, intervertebral disc or intervertebral joints.

Causes of spinal instability in the cervical region:

Injuries (sports, road accidents, etc.);

Osteochondrosis of the spine (means degenerative-dystrophic changes observed in the spine);

Congenital anomaly of the development of the intervertebral disc.

Symptoms:

Irritative pain (pain caused by irritation of nerves or their centers) is periodic in nature and intensifies after physical activity. The occurrence of pain occurs due to reflex tension (spasm) of the neck muscles.

Violation of the stability of the spine when exposed to external physiological loads.

Spinal deformity is a pathological destruction of spinal elements or displacement of the vertebrae.

Failure of the supporting complexes that protect the spinal cord from irritation and protect the spine from deformation.

Impaired or limited movement in the cervical spine.

Neurological manifestations:

radicular syndrome (lumbago, radiculitis),
muscular-neurodystrophic syndrome (decreased muscle strength, pain when palpating the affected muscle, decreased range of motion in the joint in which the affected muscle participates),
spinal syndrome - occurs when the spinal cord is compressed or its blood circulation is impaired (impaired sensitivity, twitching, numbness or weakness in the arms and legs, paresis).

Neck muscle tension. At the initial stage of the disease, increased muscle tone occurs, which leads to fatigue. Later, blood circulation in the muscles is impaired, tone decreases and malnutrition (decreased blood supply and nutrition). The ability to withstand normal physiological load is impaired and there may be a need for additional immobilization (immobilization) of the neck.

Diagnostics:

Taking anamnesis (patient interview);

Physiological examination;

X-ray examination in lateral projection and functional radiographs (in the position of maximum flexion and extension).

Treatment of cervical spine instability:

1. Conservative treatment - prescribed in the absence of severe pain and spinal symptoms.

Gentle mode (no high loads on the spine and neck);

Wearing a soft or hard collar;

Taking non-steroidal anti-inflammatory drugs (usually in tablet forms);

Painkillers, and in case of exacerbation of pain, novocaine blockades are used;

Physical therapy (a special course is being developed with an emphasis on exercises for the neck and shoulder girdle);

Manual therapy aimed at strengthening the spinal muscles (according to indications);

Physiotherapeutic treatment (magnetic therapy, ultrasound, electrophoresis);

2. Surgical treatment is aimed at restoring spinal stability and decompressing (reducing compression) of the nerve structures.

Surgical treatment is prescribed for those patients who:

Severe pain persists for 1-1.5 months, despite the treatment;

Intolerance to medications and physical procedures required during conservative treatment;

Persistent spinal and radicular syndromes caused by compression of nerve structures persist;

Vertebral subluxation due to instability.

To restore spinal stabilization, anterior or posterior spinal fusion is used.

Spinal fusion is a surgical procedure using a bone graft, which is installed between adjacent vertebrae to create their immobility.

When performing an operation using the posterior spinal fusion method (a plate fixing the cervical vertebrae is attached to the back), complications such as graft resorption or the formation of a false joint in the postoperative period may occur.

When using the anterior spinal fusion method (fixation of adjacent vertebrae occurs from the front), it is possible to reduce the subluxation and decompress the nerve structures. This method is the least traumatic for the patient and the recovery period after surgery takes much less time.

To achieve the most reliable stabilization of the spine in cases of severe post-traumatic instability, combined intervention via posterior and anterior approaches is used.

The posterior approach is a lamyectomy (dissection or removal of the vertebral arch to gain access to the spinal cord) to decompress the nerve structures. An anterior approach is used to perform spinal fusion to stabilize the spine with a graft.

Instability of the cervical spine, from now on I will call this condition for short - NSHO, brings a lot of trouble to the child’s health and requires painstaking treatment and attention from adults.

With any number of complaints do parents turn to a pediatric neurologist for this pathology. And for headaches, and for poor performance at school, and disrupted behavior! You can’t list everything at once, so let’s look at it in order. Let's start, as always, by finding out the causes of the disease.

REASONS FOR SHOP INSTABILITY

The disease is based on birth trauma in the baby. The reasons for it lie in the pathological course of labor in the mother.

Rapid birth. In this case, the baby's head enters the mother's birth canal, which is not yet prepared for his birth. Intense contractions literally push the fetus out. The contractions are so strong that the baby flies out of the tummy like a cork from a bottle. The baby's neck is injured - it is so thin and vulnerable. Swelling and bruising develop, as well as microdamage to the ligamentous apparatus of the cervical vertebrae. Occasionally, during such a fast and rapid birth, a fracture of the collarbone occurs. In some cases, there is also damage to the brachial plexus.

Prolonged labor. They are caused by weakness of labor and early discharge of amniotic fluid. The fact is that the fetal head gets stuck in the mother's birth canal. Excessive pressure is placed on the fetal cervix for many hours. This also leads to swelling and microdamage to tissue.

The umbilical cord is wrapped around the baby's neck. Another important point in the origin of NSHOP is the entanglement of the umbilical cord around the baby’s neck during childbirth, which can damage ligaments and muscles and displace cervical vertebrae.

Immediately after birth, you may not see any external changes on the baby’s body. This is very important for parents to know, because the NSHOP clinic appears much later - at 3-5 years old, and even at school. And the parents are surprised and angry - why, they say, they didn’t tell us anything at the maternity hospital!

What happens subsequently to the cervical spine? Thank God, nothing bad. Everything is overgrown and restored. But the ligaments holding the vertebrae together are relaxed and the mobility of individual vertebrae is somewhat enhanced.

The child grows, turns his head in different directions, tumbles, makes a lot of movements, and the ligaments in the cervical region weaken more and more. Anatomically, the spine is designed in such a way that two large vertebral arteries pass through special openings deep in the spine, supplying blood to the brain.

In conditions of NSOP, the arteries can be compressed and less blood flows to the brain than it should. This means a lack of nutrients and oxygen. Over time, the child may develop complaints, which we will talk about now.

SYMPTOMS OF SHOP INSTABILITY

In the acute period of cervical injury, i.e. immediately after birth and during the first months of life, signs of neurogenic torticollis, weakness of the muscles of the arms and shoulder girdle are visible.

In these cases, the pediatric neurologist prescribes treatment for the child with an osteopath, massage and physiotherapy. Over time, the external manifestations of a cervical injury are smoothed out and in the future the psychomotor development of the baby does not lag behind age norms. Everyone conveniently forgets about the birth trauma.

Starting from the age of two or three, many parents worry that the child speaks little, or is even silent. They go to a neurologist and get a consultation. The reasons for speech delay can be different. One of them is NSHOP with circulatory insufficiency in the brain. Properly organized treatment will quickly improve the situation and the child’s speech will begin to develop well.

But now the child enters school. The load increases and complaints of headaches, fatigue, restlessness, and poor memory begin to flow. The parents again turn to the pediatric neurologist. Of course, there can be many reasons for concern. It's not just about NSHOP.

Many common diseases, such as frequent colds, helminthic infestations, pyelonephritis, bronchial asthma, can be accompanied by fatigue and headaches. Having suffered a concussion can also lead to decreased performance and headaches in the long term. Finally, the long-forgotten perinatal encephalopathy, which weakens brain activity under stress, can also provoke similar complaints.

The task of a pediatric neurologist is to establish the true cause of the disease. To identify the role of instability of the cervical spine in the origin of patient complaints, the doctor resorts to appropriate examination. Now I will introduce you to some aspects of this examination. I just want to note - do not repeat the neurological examination of your child yourself. Trust the doctor! Forget about the catchphrase “Everyone can teach and heal.” You are not your child’s enemy!

DIAGNOSTICS OF SHOP INSTABILITY

There are two stages in diagnosing instability:

Clinical examination;
Instrumental data.

What symptoms can be seen during a neurological examination that will help diagnose NSOP?

1. Looking at the child’s face, you can notice the presence of Horner’s symptom, which is characterized by a narrowing of the palpebral fissure, slight retraction of the eyeball and constriction of the pupil. The nerves that provide innervation to the eyeball begin from a special center located in the cervical region. The presence of this symptom indirectly confirms a previous cervical birth injury.

2. Looking at the location of the head and shoulder girdle with an experienced eye, one can notice the presence of residual effects of neurogenic torticollis.

3. By palpation (feeling), you can determine the tension of the trapezius (shoulder) muscles. Another option for the consequences of a cervical injury is the atrophy of these muscles and the complaint of parents that the child cannot pull himself up with his arms or do push-ups from the floor.

4. Asymmetry of the rectus cervical muscles. One of the muscles is tense, hypertrophied, and on the other hand, it is not palpable at all.

5. Pain when pressing on the spinous processes of the spine, especially in the upper cervical region.

6. Limitation of head tilt to the sides is a very characteristic symptom!

P.S. Points 2-6 are characteristic symptoms in children from about 5 years of age.

Instrumental data:

Radiography.

To identify vertebral instability, an x-ray taken in a lateral projection is 100% indicative. Moreover, they do it with functional tests, i.e. with the head lowered and thrown back. Additionally, they take a picture through the mouth, in which you can see the subluxation of the main vertebra.

But magnetic resonance imaging is not necessary to clarify the diagnosis of instability. It's absolutely useless. X-ray is sufficient.

Doppler ultrasound.

It is imperative to do this study, because you can see the presence of compression of the right or left vertebral artery; asymmetry of cerebral blood flow and disturbance of venous outflow. For a neurologist, this is very important data.

Instability of the cervical spine is associated with birth trauma. Very often, clinical symptoms do not appear in a child immediately, but years after birth. And if the diagnostics confirm the diagnosis, you should proceed to treatment.

TREATMENT OF SHOP INSTABILITY IN CHILDREN

Therapeutic measures must be carried out in combination. Often mothers say that they have had several sessions with an osteopath or had a massage course. That's all! This completed the treatment. This is a very wrong approach to treating such children.

After all, the goal of treatment is not only to “put the cervical vertebrae in place” and thereby eliminate the obstruction to blood flow through the vertebral arteries. It is very important to further maximize this blood flow so that the brain receives the best nutrition and blood supply and begins to develop more intensively. Only then will the complaints of headaches go away, the child will behave better and study better. And this, my friends, is not done quickly. And it is imperative to include several different procedures in the treatment course.

Osteopathy.
This method affects the tone of the neck muscles, which are located very deeply. Conventional massage affects only the superficial muscles of the neck. As a result of the osteopath's manipulations, the cervical vertebrae move into place, pressure on the vertebral arteries is eliminated, and cerebral circulation improves. Usually procedures are done once a week, the number may vary. This issue is resolved by the osteopath himself. After the session, you need to behave more carefully - run and jump less. It is strictly forbidden to tumble. It is better to exempt your child from physical education lessons. It is recommended to wear a Shants collar during the day. Periodically you need to be examined by an osteopath and maintain the correct condition of the spine.

Classic massage.
It is also very widely used in NSOP. It cannot be combined with osteopathy. Thanks to massage, tense muscles relax. Weakened muscles are strengthened. Intense metabolism occurs in the muscles, blood circulation increases, and microcirculation improves. Clinical manifestations of the disease disappear.

Physiotherapy.
Usually combined with massage. Most often, electrophoresis is prescribed with vasodilating drugs, which further improves cerebral circulation.

Physiotherapy.
In my opinion, this is almost the most important way to treat instability of the spine. Of course, you need to start treatment with massage, osteopathy and physiotherapy. But to consolidate the result - physical therapy. The most interesting thing is that if you, dear parents, really want to save your child from instability, as well as prevent future development, physical exercises should be done daily throughout his life. Yes Yes! Otherwise, the muscles will gradually return to their original state and clinical complaints will appear again. Therefore, NSHOP is very important in childhood.

It will be very good if your child starts visiting the pool. Swimming improves the statics of the spine. It is useful to do gymnastics and choreography. In general, strengthen the neck muscles, as well as the shoulder girdle, arms, and torso.

During the course of treatment, the neurologist will prescribe symptomatic medications to the child: vasodilators, nootropics, sedatives and other drugs. In general, it is necessary to undergo treatment under the guidance of a pediatric neurologist, who will first examine the child and, based on the data obtained, draw up a treatment program. Will watch him. A few years of attentive attention to the child’s problem and everything will pass. NSHOP must be cured in childhood, so that later your son or daughter does not suffer from cervical osteochondrosis.

Instability of the cervical spine in children undoubtedly impairs cerebral circulation. Even despite the presence of collateral circulation. This is confirmed by instrumental examination methods, in particular Doppler ultrasound.

It is impossible to allow a deficiency of nutrients in the child’s brain. Consult a pediatric neurologist promptly, get examined and undergo corrective treatment. In this case, the child will have a good prognosis and will not subsequently suffer from headaches and dizziness.