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Lian P, Chen H, Wang W, Zhu C, Tu Q, Ma X, Xia H, Yi H. Evaluation of the Anatomical Reference Point in Posterior Minimally Invasive Atlantoaxial Spine Surgery: A Cadaveric Anatomical Study. Orthop Surg 2024; 16:943-952. [PMID: 38433589 PMCID: PMC10984822 DOI: 10.1111/os.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE Minimally invasive atlantoaxial surgery offers the benefits of reduced trauma and quicker recovery. Previous studies have focused on feasibility and technical aspects, but the lack of comprehensive safety information has limited its availability and widespread use. This study proposes to define the feasibility and range of surgical safety using the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique as a reference point. METHODS Dissection was performed on 10 fresh cadavers to define the anatomical reference point as the intersection of the greater occipital nerve and the inferior border of the inferior cephalic oblique muscle. The study aimed to analyze the safety range of minimally invasive atlantoaxial fusion surgery by measuring the distance between the anatomical reference point and the transverse foramen of the axis, the distance between the anatomical reference point and the superior border of the posterior arch of the atlas, and the distance between the anatomical reference point and the spinal canal. Measurements were compared using Student's t test. RESULTS The point where the occipital greater nerve intersects with the inferior border of the inferior cephalic oblique muscle was defined as the anatomical marker for minimally invasive posterior atlantoaxial surgery. The distance between this anatomical marker and the transverse foramen of the axis was measured to be 9.32 ± 2.04 mm. Additionally, the distance to the superior border of the posterior arch of the atlas was found to be 21.29 ± 1.93 mm, and the distance to the spinal canal was measured to be 11.53 ± 2.18 mm. These measurement results can aid surgeons in protecting the vertebral artery and dura mater during minimally invasive posterior atlantoaxial surgery. CONCLUSIONS The intersection of the greater occipital nerve with the inferior border of the inferior cephalic oblique muscle is a safe and reliable anatomical landmark in minimally invasive posterior atlantoaxial surgery.
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Affiliation(s)
- Peirong Lian
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Hu Chen
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Wanshun Wang
- The Second Clinical Medical CollegeGuangzhou University of Chinese MedicineGuangzhouChina
| | - Changrong Zhu
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Qiang Tu
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Xiangyang Ma
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Hong Xia
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
| | - Honglei Yi
- The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of OrthopaedicPeople's Liberation Army General Hospital of Southern Theatre CommandGuangzhouChina
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Song Y, Lai HX, Song TW, Gong J, Liu B, Chi YY, Yue C, Zhang J, Sun SZ, Zhang CH, Tang W, Fan N, Yu WH, Wang YF, Hack GD, Yu SB, Zhang JF, Sui HJ. The growth and developmental of the myodural bridge and its associated structures in the human fetus. Sci Rep 2023; 13:13421. [PMID: 37591924 PMCID: PMC10435443 DOI: 10.1038/s41598-023-40709-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/16/2023] [Indexed: 08/19/2023] Open
Abstract
Myodural bridge (MDB) is a dense connective tissue between suboccipital muscle and dura mater. However, there are few reports on the development and maturation of the human MDB. This study aims to explore the developmental relationship between suboccipital muscle and MDB. 30 head and neck specimens from human fetuses (F) ranging from the 12th to 41st week (W) were made into histological sections. The F12W sections showed evidence that the dura mater dominated by fibroblasts, attached to the posterior atlanto-axial membrane (PAAM) which completely sealed the atlanto-axial space. In the F13W stage, myofibrils of the suboccipital muscle fibers increased significantly in number. At the F14W stage, a gap was observed at the caudal end of the PAAM. Numerous myodural bridge-like structures were observed blending into the dura mater through the gap. At the F19W stage, muscle cells mature. Starting at the F21W stage, the MDB were observed as fibroblasts that cross the atlanto-axial interspace and attach to the dura mater. Therefore, the traction generated by the suboccipital muscles seems to promote the maturity of MDB. This study will provide new morphological knowledge to support future research on the function of the human MDB and regulating the development mechanism of MDB.
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Affiliation(s)
- Yang Song
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Hua-Xun Lai
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Ting-Wei Song
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
- Department of Neurology, Angang Group Company General Hospital, Anshan, 114000, Liaoning, China
| | - Jin Gong
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Bo Liu
- Department of Histology and Embryology, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yan-Yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Chen Yue
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
- Department of Obstetrics and Gynecology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning, China
| | - Jing Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Shi-Zhu Sun
- Basic and Clinical Medicine Teaching Laboratory, School of Medicine, Sun-Yat-Sen-University, Guangdong, 518100, China
| | - Cheng-Hong Zhang
- Morphology Laboratory, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Wei Tang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Ning Fan
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Wei-Hua Yu
- Department of Obstetrics and Gynecology, Lvshun District Hospital, Dalian, 116044, Liaoning, China
| | - Yi-Fei Wang
- Department of Obstetrics and Gynecology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, Liaoning, China
| | - Gary D Hack
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Jian-Fei Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China.
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Jiang WB, Samuel OC, Li Z, Chen W, Sui HJ. Effectiveness of craniosacral therapy in the human suboccipital region on hamstring muscle: A meta-analysis based on current evidence. Medicine (Baltimore) 2023; 102:e32744. [PMID: 36749266 PMCID: PMC9901966 DOI: 10.1097/md.0000000000032744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Craniosacral therapy (CST) has remained controversial in the treatment of musculoskeletal disorders. To our knowledge, there is no larger sample size of research to demonstrate the effectiveness of craniosacral therapy in the human suboccipital region on hamstring muscle. METHODS To study whether the CST in the human suboccipital region could have a remote effect on the flexibility of the hamstring muscles, the Cochrane Library, Medline/Pubmed, CNKI, Embase, and Google Scholar were searched. Clinical trials assessing the effects of CST in short hamstring syndrome patients were eligible. Mean differences (MD) and 95% confidence intervals (CI) were calculated for the straight leg raise test (primary outcomes). The quality of the included studies was assessed using the Newcastle-Ottawa Scale. RevMan 5.3 software was used for data analysis. RESULTS Five controlled trials with a total of 238 participants were included. CST could effectively relieve the symptoms of short hamstring syndrome patients [the overall MD -9.47, 95% confidence interval (CI) -15.82 to -3.12, P < .000001]. The CST was better than the proprioceptive neuromuscular facilitation technique (MD 3.09, 95% CI 1.48-4.70, P = .0002). Sensitivity analysis shows that the frequency of treatment and who did the experiment might be the main sources of impact results. CONCLUSION CST could change the flexibility of the hamstring muscles. CST had a better curative effect when compared to proprioceptive neuromuscular facilitation technique on the hamstring muscles.
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Affiliation(s)
- Wen-Bin Jiang
- Department of Anatomy, Dalian Medical University, Dalian, China
| | | | - Zhe Li
- Department of Anatomy, Guang Dong Medical University, Dong Guan, China
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hong-Jin Sui
- Department of Anatomy, Dalian Medical University, Dalian, China
- * Correspondence: Hong-Jin Sui, Department of Anatomy, Dalian Medical University, Dalian 116044, China (e-mail: )
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Plaut S. Suggesting a mechanism for acupuncture as a global percutaneous needle fasciotomy that respects tensegrity principles for treating fibromyalgia. Front Med (Lausanne) 2023; 9:952159. [PMID: 36777160 PMCID: PMC9911817 DOI: 10.3389/fmed.2022.952159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/30/2022] [Indexed: 01/28/2023] Open
Abstract
Acupuncture is a minimally invasive therapeutic method that uses small caliber needles while inserting them through the skin into various areas of the body. Some empirical studies find evidence to support the use of acupuncture as a treatment for certain medical conditions, however, this peculiar practice is widely considered as the domain of alternative and non-evidence-based medicine. Several mechanisms have been suggested in an attempt to explain the therapeutic action of acupuncture, but the way in which acupuncture alleviates chronic non-cancer pain or psychosomatic and psychiatric disorders is not fully understood. A recent study suggested a theoretical model (coined "Fascial Armoring") with a cellular pathway to help explain the pathogenesis of myofascial pain/fibromyalgia syndrome and functional psychosomatic syndromes. It proposes that these syndromes are a spectrum of a single medical entity that involves myofibroblasts with contractile activity in fascia and aberrant extracellular matrix (ECM) remodeling, which may lead to widespread mechanical tension and compression. This can help explain diverse psycho-somatic manifestations of fibromyalgia-like syndromes. Fascia is a continuous interconnected tissue network that extends throughout the body and has qualities of bio-tensegrity. Previous studies show that a mechanical action by needling induces soft tissue changes and lowers the shear modulus and stiffness in myofascial tissue. This hypothesis and theory paper offers a new mechanism for acupuncture therapy as a global percutaneous needle fasciotomy that respects tensegrity principles (tensegrity-based needling), in light of the theoretical model of "Fascial Armoring." The translation of this model to other medical conditions carries potential to advance therapies. These days opioid overuse and over-prescription are ubiquitous, as well as chronic pain and suffering.
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Affiliation(s)
- Shiloh Plaut
- *Correspondence: Shiloh Plaut, , ; orcid.org/0000-0001-5823-3390
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Shao B, Poggi JA, Amaral-Nieves N, Wojcik D, Ma KL, Leary OP, Klinge PM. Compromised Cranio-Spinal Suspension in Chiari Malformation Type 1: A Potential Role as Secondary Pathophysiology. J Clin Med 2022; 11:jcm11247437. [PMID: 36556053 PMCID: PMC9788407 DOI: 10.3390/jcm11247437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
In Chiari Malformation Type I (CM1), low-lying tonsils obstruct the cisterna magna at the foramen magnum, thereby compromising the essential juncture between the cranial and spinal compartments. The anatomical obstruction of the cisterna magna inhibits bi-directional CSF flow as well as CSF pulse pressure equilibration between the intracranial compartment and the intraspinal compartment in response to instances of increased intracranial pressure. Less understood, however, are the roles of the spinal cord suspension structures at the craniocervical junction which lend viscoelastic support to the spinal cord and tonsils, as well as maintain the anatomical integrity of the cisterna magna and the dura. These include extradural ligaments including the myodural bridges (MDBs), as well as intradural dentate ligaments and the arachnoid framework. We propose that when these elements are disrupted by the cisterna magna obstruction, tonsillar pathology, and altered CSF dynamics, there may arise a secondary pathophysiology of compromised and dysfunctional cranio-spinal suspension in CM1. We present intraoperative images and videos captured during surgical exposure of the craniocervical junction in CM1 to illustrate this proposal.
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The Relationship Between the Myovertebral Structures and Idiopathic Cerebrospinal Fluid Leaks in Whiplash Injuries. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zhuang J, Gong J, Hack GD, Chi YY, Song Y, Yu SB, Sui HJ. A new concept of the fiber composition of cervical spinal dura mater: an investigation utilizing the P45 sheet plastination technique. Surg Radiol Anat 2022; 44:877-882. [PMID: 35715572 PMCID: PMC9246786 DOI: 10.1007/s00276-022-02962-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/09/2022] [Indexed: 12/03/2022]
Abstract
Purpose Few reports have been published regarding the microanatomy of the dura mater located at the craniovertebral junction (CVJ). In clinic, the precise microanatomy of the CVJ dura mater would be taken into account, for reducing surgical complications and ineffective surgical outcomes. The main objective of the present investigation was to further elucidate the fiber composition and sources of the cervical spinal dura mater. Methods The formalin-fixed adult head and neck specimens (n = 21) were obtained and P45 plastinated section method was utilized for the present study. The fibers of the upper cervical spinal dura mater (SDM) were examined in the P45 sagittal sections in the CVJ area. All photographic documentation was performed via a Canon EOS 7D Mark camera. Results The posterior wall of the SDM sac at CVJ was found to be composed of stratified fibers, which are derived from three sources: the cerebral dura mater, the occipital periosteum, and the myodural bridge (MDB). The proper layer of the cerebral dura mater passes over the brim of the foramen magnum and enters the vertebral canal to form the inner layer of the SDM, and the fibers originating from the periosteum of the brim of the foramen magnum form the middle layer. The fibers of the MDB are inserted into the SDM and form its outer layer. It was found that the total number of fibers from each origin varied in humans. Conclusion At the CVJ, the posterior wall of the SDM is a multi-layered structure composed of three different originated fibers. The cerebral dura mater, the periosteum located at the brim of the foramen magnum, and MDB contribute to the formation of the SDM. The present study would be beneficial to the choice of surgical approach at the CVJ and the protection of the SDB.
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Affiliation(s)
- Jing Zhuang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, 116044, People's Republic of China
| | - Jin Gong
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, 116044, People's Republic of China
| | - Gary D Hack
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Yan-Yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, 116044, People's Republic of China
| | - Yang Song
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, 116044, People's Republic of China
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, 116044, People's Republic of China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, 116044, People's Republic of China.
- Expert Workstation, Dalian Hoffen Preservation Technique Institution, Dalian, 116052, China.
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Zhang ZX, Gong J, Yu SB, Li C, Sun JX, Ding SW, Ma GJ, Sun SZ, Zhou L, Hack GD, Zheng N, Sui HJ. A specialized myodural bridge named occipital-dural muscle in the narrow-ridged finless porpoise (Neophocaena asiaeorientalis). Sci Rep 2021; 11:15485. [PMID: 34326428 PMCID: PMC8322066 DOI: 10.1038/s41598-021-95070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
A dense bridge-like tissue named the myodural bridge (MDB) connecting the suboccipital muscles to the spinal dura mater was originally discovered in humans. However, recent animal studies have revealed that the MDB appears to be an evolutionarily conserved anatomic structure which may have significant physiological functions. Our previous investigations have confirmed the existence of the MDB in finless porpoises. The present authors conducted research to expound on the specificity of the MDB in the porpoise Neophocana asiaeorientalis (N.asiaeorientalis). Five carcasses of N.asiaeorientalis, with formalin fixation, were used for the present study. Two of the carcasses were used for head and neck CT scanning, three-dimensional reconstructions, and gross dissection of the suboccipital region. Another carcass was used for a P45 plastination study. Also, a carcass was used for a histological analysis of the suboccipital region and also one was used for a Scanning Electron Microscopy study. The results revealed that the MDB of the N.asiaeorientalis is actually an independent muscle originating from the caudal border of the occiput, passing through the posterior atlanto-occipital interspace, and then attaches to the cervical spinal dura mater. Thus the so called MDB of the N.asiaeorientalis is actually an independent and uniquely specialized muscle. Based on the origin and insertion of this muscle, the present authors name it the ‘Occipital-Dural Muscle’. It appears that the direct pull of this muscle on the cervical spinal dura mater may affect the circulation of the cerebrospinal fluid by altering the volume of the subarachnoid space via a pumping action.
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Affiliation(s)
- Zhao-Xi Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Jin Gong
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Chan Li
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Jing-Xian Sun
- College of Fisheries and Life Science, Dalian Ocean University, Dalian, China
| | - Shuai-Wen Ding
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Guo-Jun Ma
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Shi-Zhu Sun
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Lin Zhou
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Gary D Hack
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Nan Zheng
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China. .,Dalian Hoffen Preservation Technique Institution, Dalian, China.
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Klinge PM, McElroy A, Donahue JE, Brinker T, Gokaslan ZL, Beland MD. Abnormal spinal cord motion at the craniocervical junction in hypermobile Ehlers-Danlos patients. J Neurosurg Spine 2021; 35:18-24. [PMID: 34020423 DOI: 10.3171/2020.10.spine201765] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The craniocervical junction (CCJ) is anatomically complex and comprises multiple joints that allow for wide head and neck movements. The thecal sac must adjust to such movements. Accordingly, the thecal sac is not rigidly attached to the bony spinal canal but instead tethered by fibrous suspension ligaments, including myodural bridges (MDBs). The authors hypothesized that pathological spinal cord motion is due to the laxity of such suspension bands in patients with connective tissue disorders, e.g., hypermobile Ehlers-Danlos syndrome (EDS). METHODS The ultrastructure of MDBs that were intraoperatively harvested from patients with Chiari malformation was investigated with transmission electron microscopy, and 8 patients with EDS were compared with 8 patients without EDS. MRI was used to exclude patients with EDS and craniocervical instability (CCI). Real-time ultrasound was used to compare the spinal cord at C1-2 of 20 patients with EDS with those of 18 healthy control participants. RESULTS The ultrastructural damage of the collagen fibrils of the MDBs was distinct in patients with EDS, indicating a pathological mechanical laxity. In patients with EDS, ultrasound revealed increased cardiac pulsatory motion and irregular displacement of the spinal cord during head movements. CONCLUSIONS Laxity of spinal cord suspension ligaments and the associated spinal cord motion disorder are possible pathogenic factors for chronic neck pain and headache in patients with EDS but without radiologically proven CCI.
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Affiliation(s)
| | | | | | - Thomas Brinker
- 3Department of Neurosurgery, Medical School Hannover, Germany
| | | | - Michael D Beland
- 4Radiology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
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Hallgren RC, Rowan JJ. Assessment of potential strain injury to rectus capitis posterior minor muscles during whiplash type distortions of the cervical spine. J Osteopath Med 2021; 121:747-753. [PMID: 34087970 DOI: 10.1515/jom-2021-0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/10/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Whiplash type injuries resulting from a rear end motor vehicle accident (REMVA) are thought to be caused by excessive loading and displacement of structural components of the cervical spine. On impact, the seat propels the driver's torso forward relative to the head, resulting in forced flexion of the occipitoatlantal (OA) joint, accompanied by forced stretching of the rectus capitis posterior minor (RCPm) muscles. Flexion of the OA joint and stretching of the RCPm muscles continues to increase until the vehicle's headrest strikes the back of the driver's head. It is known that externally applied forces that attempt to move the OA joint beyond its anatomic barrier can result in fracture, dislocation, or soft tissue damage to its structural components. However, the magnitude of headrest backset, defined as the distance between the driver's head and the vehicle's headrest, that would result in RCPm muscles being stretched to a length that would put them at risk for a muscle strain injury is unknown. OBJECTIVES To quantify the relationships among flexion of the OA joint, RCPm muscle stretch, and backset, and to quantify the biomechanical response of RCPm muscles to increasing levels of axial load due to stretching. METHODS Unembalmed head and neck specimens from three White females aged 85, 63, and 70 years were obtained from the Anatomical Services Division at the University of Maryland. Donors had provided written consent allowing use of their body for research purposes. Using an analytic model of the OA joint, the relationships between flexion of the OA joint and RCPm muscle stretch as a function of backset were estimated. RCPm muscles were removed from the cadavers and forcibly stretched using a servomechanism controlled hydraulic testing machine to quantify the load/displacement properties. After testing, the tissues were sectioned, mounted, and stained using Masson's trichrome to selectively stain muscle fibers red and collagen blue. RESULTS Forced flexion of the OA joint was seen to be directly related to the magnitude of headrest backset. For values of backset greater than 7.2 cm, biomechanical testing of the RCPm muscles revealed that strain injuries ranged from the tearing of a few muscle fibers to complete rupture of the muscle and separation of the tendon at the posterior process of C1. CONCLUSIONS Results showed that headrest backset at the time of vehicle impact is an important factor in estimating the risk of muscle strain injury to RCPm muscles. Muscle strain injury would be expected to impact the functional relationship between the RCPm muscles and the pain sensitive spinal dura. Physicians should be alert to the possibility that cervicogenic pain patients who have experienced whiplash associated with REMVA may show clinically relevant structural damage to the RCPm muscles on MRI.
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Affiliation(s)
- Richard C Hallgren
- Department of Physical Medicine & Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - Jacob J Rowan
- Department of Osteopathic Manipulative Medicine, Michigan State University, East Lansing, MI, USA
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