Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System.

In this paper we synthesize an expansive body of literature examining the multifaceted influence of chiropractic care on processes within and modulators of the neuroendocrine-immune (NEI) system, for the purpose of generating an inductive hypothesis regarding the potential impacts of chiropractic care on integrated physiology. Taking a broad, interdisciplinary, and integrative view of two decades of research-documented outcomes of chiropractic care, inclusive of reports ranging from systematic and meta-analysis and randomized and observational trials to case and cohort studies, this review encapsulates a rigorous analysis of research and suggests the appropriateness of a more integrative perspective on the impact of chiropractic care on systemic physiology. A novel perspective on the salutogenic, health-promoting effects of chiropractic adjustment is presented, focused on the improvement of physical indicators of well-being and adaptability such as blood pressure, heart rate variability, and sleep, potential benefits that may be facilitated through multiple neurologically mediated pathways. Our findings support the biological plausibility of complex benefits from chiropractic intervention that is not limited to simple neuromusculoskeletal outcomes and open new avenues for future research, specifically the exploration and mapping of the precise neural pathways and networks influenced by chiropractic adjustment.

Secondary Analysis of a Dataset to Estimate the Prevalence of Vertebral Subluxation and Its Implications for Health Promotion and Prevention.

Background Vertebral subluxation (VS) is a clinical entity defined as a misalignment of the spine affecting biomechanical and neurological function. The identification and correction of VS is the primary focus of the chiropractic profession. The purpose of this study is to estimate VS prevalence using a sample of individuals presenting for chiropractic care and explore the preventative public health implications of VS through the promotion of overall health and function. Methodology A brief review of the literature was conducted to support an operational definition for VS that incorporated neurologic and kinesiologic exam components. A retrospective, quantitative analysis of a multi-clinic dataset was then performed using this operational definition. Descriptive statistics on patient demographic data included age, gender, and past health history characteristics. In addition to calculating estimates of the overall prevalence of VS, age- and gender-stratified estimates in the different clinics were calculated to allow for potential variations. Results A total of 1,851 patient records from seven chiropractic clinics in four states were obtained. The mean age of patients was 43.48 (SD = 16.8, range = 18-91 years). There were more females (n = 927, 64.6%) than males who presented for chiropractic care. Patients reported various reasons for seeking chiropractic care, including, spinal or extremity pain, numbness, or tingling; headaches; ear, nose, and throat-related issues; or visceral issues. Mental health concerns, neurocognitive issues, and concerns about general health were also noted as reasons for care. The overall prevalence of VS was 78.55% (95% CI = 76.68-80.42). Female and male prevalence of VS was 77.17% and 80.15%, respectively; notably, all per-clinic, age, or gender-stratified prevalences were ≥50%. Conclusions To date, this is the first study of its magnitude and application of an operational definition to estimate the prevalence of VS. Albeit nonrandom, the sample had a broad geographic distribution. The results of this study suggest a high rate of prevalence of VS in a sample of individuals who sought chiropractic care. Concerns about general health and wellness were represented in the sample and suggest chiropractic may serve a primary prevention function in the absence of disease or injury. Further investigation into the epidemiology of VS and its role in health promotion and prevention is recommended.

Spinal decompression and stabilisation in a cat with lumbar vertebral pathological fracture and subluxation, following discospondylitis and spinal epidural empyema.

Case series summary: A 1-year-old castrated male Maine Coon cat was referred because of a 1-week history of progressive spastic non-ambulatory paraparesis. An MRI examination of the thoracolumbar spine showed multiple lytic lesions, with the most aggressive one centred on the adjacent endplates of L1-L2 and its associated disc. Ventral new bone formation, L1 vertebral body shortening and mild dorsal displacement of the caudal aspect of L1 were noted. Contrast enhancement of both paravertebral soft tissue and extradural lesion was present. These findings were compatible with L1-L2 discospondylitis (DS), spinal epidural empyema (SEE), with secondary L1 pathological vertebral fracture, subluxation and spinal cord compression. CT of the thoracolumbar spine, abdomen and thorax confirmed these findings. The patient deteriorated to paraplegia with absent nociception, despite initial medical therapy. A right-sided L1-L2 hemilaminectomy and spinal decompression were then performed, followed by application of a unilateral construct comprising four smooth arthrodesis wires and polymethylmethacrylate (PMMA). Staphylococcus aureus was isolated from both epidural material, intraoperatively sampled and blood culture. Antibiotic therapy was continued for 6 weeks, based on susceptibility results. The outcome was excellent, with a gradual improvement and complete neurological recovery at the 8-week postoperative check. Repeated spinal radiographs showed an intact apparatus and marked signs of vertebral fusion. At the 14-month follow-up examination, the cat remained free of clinical signs. Relevance and novel information: To the authors' knowledge, this is the first case report of SEE and DS in a cat that required surgical stabilisation. The outcome was still optimal, despite the rapid neurological deterioration.

Veterinary Spinal Manipulative Therapy or Animal Chiropractic in Veterinary Rehabilitation.

Veterinary rehabilitation is a multimodal diagnostic and treatment approach that is recommended and provided to patients daily. One therapeutic modality that may be beneficial (diagnostically and therapeutically) is veterinary spinal manipulative therapy or animal chiropractic (AC). AC is a receptor-based health-care modality being provided more frequently in veterinary practices. All clinicians should strive to understand the mode of action, indications, contraindications, how it affects the patient from the neuro-anatomical and biomechanical point of view, and most importantly, when not to provide the requested modality, as further diagnostics may be indicated.

Remodeling morphology of the subluxated osteotomy vertebra in closing-opening wedge osteotomy in ankylosing spondylitis: would the anterior bony beak blunt?

INTRODUCTION: To investigate the remodeling morphology of subluxated osteotomy vertebra in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis after single-level closing-opening wedge osteotomy (COWO). MATERIALS AND METHODS: Standing lateral radiographs were taken to evaluate sagittal parameters including lumbar lordosis (LL), C7 sagittal vertical axis (SVA), global kyphosis (GK), sacral slope (SS), and pelvic tilt (PT). Radiographic parameters of the osteotomy vertebra included osteotomized vertebra angle (OVA), sagittal translation (ST), anterior height (AH), posterior height (PH), and middle height (MH) of the osteotomy vertebrae. Furthermore, lateral projection area of the vertebral body was also measured to evaluate the remodeling of the osteotomy vertebrae. RESULTS: Sixty AS patients who underwent single-level lumbar COWO with a minimal 2-year follow-up were included. The cohort consisted of 54 males and 6 females with an average age of 36.6 years. All patients were divided into two groups according to the development of vertebral subluxation (VS): 15 in VS group (ST ≥ 5 mm), 45 in non-VS group (ST < 5 mm). There was significant difference in the correction of GK, SVA, and the loss of correction of SVA between AS patients with and without VS. Significant difference in vertebra-related parameters regarding AH and OVA was found between VS group and non-VS group (P < 0.05). CONCLUSIONS: After COWO, new bone formation narrowing the gap and adaptive resorption of the anterior bony beak at the osteotomy level during follow-up was surprisingly favorable. However, the ability of spinal canal remodeling is limited in patients complicated with VS.

Prevalence of Cervical Spondylolisthesis in the Sagittal Plane Using Radiographic Imaging in a Pediatric Population: A Cross Sectional Analysis of Vertebral Subluxation.

INTRODUCTION: Cervical Spondylolisthesis (CS) in children is under-studied. This cross-sectional study reports the CS prevalence in children. MATERIALS & METHODS: Subjects were selected from a private practice. Inclusion criteria: 0-17 years of age; documented demographics and health complaints; neutral lateral cervical (NLC) radiographs; and CS. Exclusion criteria: pseudosubluxation. RESULTS: 342 NLC radiographs were analyzed. 73 (21.3%) had CS greater than 2.0 mm. 42 (57.5%) had no musculoskeletal complaints. 8 (2.3%) had the presence of a CS greater than 3.5 mm. 5 (62.5%) had no musculoskeletal complaints. DISCUSSION: Pediatric populations endure various traumas. Pediatric cervical spine biomechanics has an increased risk of upper cervical spine injury. Regular spinal radiographic exams may help identify serious spinal conditions in their pre-symptomatic state. CONCLUSION: CS in pediatric populations is under-studied. CS is present in children and adolescents with and without symptoms.

Remission of anosmia in a patient receiving chiropractic care: A case report.

OBJECTIVE: To chronicle the remission of anosmia in a 79-year-old female receiving chiropractic care using the Activator Methods Chiropractic Technique (AMCT) protocol. CLINICAL FEATURES: A 79-year-old white female with a 4-year history of medically diagnosed anosmia. Postural alterations, reduction in cervical ranges of motion (ROM), and absent cranial nerve I function were found in conjunction with vertebral subluxation throughout the spine and mild to severe degenerative changes throughout the spine present on radiographic studies. INTERVENTION & OUTCOMES: Chiropractic care using AMCT was provided for the assessment and correction of vertebral subluxations. The patient reported subjective improvement in olfaction, physical functioning and life enjoyment, and demonstrated objective improvement in posture, cervical ROM, cranial nerve I function. CONCLUSION: A course of chiropractic care, following the AMCT protocol, was associated with remission of anosmia.

Suspected hereditary cervicothoracic vertebral subluxation with cervical myopathy in Poll Merino sheep.

BACKGROUND: Cervicothoracic vertebral subluxation in sheep presents as a postural and locomotor disorder, and has been described in several breeds in Australia and overseas. Cervical myopathy may also be present in these cases. CASE REPORT: A New South Wales sheep producer reported a postural and locomotor disorder with a low prevalence in his Poll Merino stud flock, affecting neonate, weaner and adult sheep. Animals with postural abnormalities, variable degrees of ataxia and proprioceptive deficits involving both fore and hind limbs were described. Abnormalities of the cervicothoracic vertebral column were identified grossly during necropsy, with misalignment and consequent narrowing of the posterior cervical spinal canal. Lesions ranging from pallor (cellular degeneration) to white streaky lesions with pinpoint haemorrhage (necrosis) were identified in the cervicothoracic paravertebral musculature of affected animals. Boney abnormalities were further characterised by imaging studies. Pedigree analysis of the very extensive breeding and disease incident records available for this flock suggested that the disease was inherited. A similar case recognised in a separate New South Wales Poll Merino flock is also described. CONCLUSION: This report describes an entity of cervicothoracic vertebral subluxation in two Poll Merino sheep flocks, with cervical myopathy also identified in one, with preliminary evidence in the primary case that there is likely to be a hereditary basis. The two cases outlined in this report resemble the findings of several historical investigations into ovine flock postural disorders in Australia and beyond.

Vertebral subluxation during three-column osteotomy in surgical correction of adult spine deformity: incidence, risk factors, and complications.

PURPOSE: To investigate incidence, risk factors, and complications of vertebral subluxation (VS) during three-column osteotomy in surgical correction of adult spine deformity. METHODS: Adult spine deformity patients who underwent three-column osteotomies including VCR, PSO, and other modified types from March 2000 to December 2014 in our center were retrospectively reviewed. The following parameters were measured pre- and postoperatively: Cobb angle of main curve, global kyphosis, sagittal vertical axis, and kyphosis flexibility. Radiographic parameters between groups (VCR vs. PSO and subluxation vs. non-subluxation) were compared. RESULTS: 171 ASD patients were recruited, 18 of which (10.5%) developed sagittal vertebral subluxation at the osteotomy site. 5 of 18 patients (27.8%) developed neurological complications after surgery. For these five patients, two patients got partial recovery, and three got complete recovery at 2-year follow-up. 116 patients underwent PSO, 12 of which (10.3%) developed sagittal vertebral subluxation. In 55 patients receiving VCR, 6 (10.9%) developed sagittal vertebral subluxation. No significant difference was noted between the two groups (P > 0.05). The mean age of VS group was larger than that of non-VS group (46.2 vs. 34.2, P < 0.05). VS group had less kyphosis flexibility (11 vs. 23%, P < 0.05). More patients in VS group had preoperative sagittal VS as compared to non-VS group (77.8 vs. 20.9%, P < 0.05). VS group had more neurological complications than non-VS group (25 vs. 5.4%, P < 0.05). CONCLUSION: VS occurred in one-tenth of patients receiving three-column osteotomies, one-fourth of which would develop neurological deficits. Older age, rigid kyphosis, and the pre-existence of VS were risk factors for developing VS.

Radiological morphology variances of osteotomized vertebra-disc complex following pedicle subtraction osteotomy for ankylosing spondylitis with thoracolumbar kyphosis: the incidence, mechanisms, and prognosis.

BACKGROUND CONTEXT: Inaccurate osteotomy cut along with incomplete or even subluxated bone-on-bone closure of osteotomy gap following pedicle subtraction osteotomy (PSO) may be disastrous, hampering the lordosing effect and increasing the likelihood of complications. The inelastic yet osteoporotic spine in ankylosing spondylitis (AS) is specially predisposed to such suboptimal osteotomy, while the relevant data concerning this issue are scarce. PURPOSE: This study aimed to analyze the incidence of radiological morphology variances (RMV) of osteotomized vertebra-disc complex (OVDC) following PSO in patients with kyphotic AS, conceptualize the mechanisms of the deviated morphology, and investigate the prognosis. STUDY DESIGN: This is a retrospective radiological data analysis. PATIENT SAMPLE: The sample being screened comprises 71 patients with thoracolumbar kyphotic AS who underwent single-level PSO at our hospital between March 2006 and February 2014. They were stratified by the presence of bridging syndesmophytes (BS) locating within the OVDC. OUTCOME MEASURES: Any irregular radiological configuration of OVDC other than the wedge morphology would be considered as RMV and were studied with care to fully describe and classify the spectrum of deviated morphologic features. Multiple spinopelvic sagittal parameters were measured to assess both the regional lordosing effect and the global realignment of sagittal spinal profile. METHODS: For each selected patient with confirmed RMV, the radiological morphology was assessed, defined, and categorized. The prognosis involving surgical corrections and maintenance of spinopelvic sagittal parameters, as well as the remodeling in disordered osteotomized vertebral shape over time, were also investigated. RESULTS: The incidence of RMV was 21.9% in positive BS group (PG) and 30.8% in negative BS group (NG). Inappropriate angle and range of osteotomy accounted for the largest share (1 pts for PG and 10 pts for NG, 57.9%) of mechanisms responsible for RMV, followed by vertebral subluxation (VS) (5 pts for PG and 2 pts for NG, 36.8%) and failed osteotomy gap closure (1 pts for PG, 5.3%). For these patients, the mean bony lordosing effect per PSO segment was 36.0°±8.9° postoperatively, and decreased to 34.7°±8.7° by a mean follow-up of 3 years (p=.076). The magnitude of neighboring disc opening was significantly higher in NG (10.2°±6.5° vs. 2.4°±3.2°, p=.009). The global kyphosis and sagittal vertical axis were significantly corrected (77.0°±21.2° vs. 24.4°±18.8°; 160.6°±72.4° vs. 48.2°±38.6 mm, all p<.001) and remained stable by the ultimate follow-up (p>.05). No devastating neurologic deficits were noticed. Patients with VS and failed osteotomy gap closure exclusively showed solid bone healing and adaptive remodeling without rod breakage at final follow-up. CONCLUSIONS: Radiological morphology variances of OVDC were a high occurrence following PSO in AS, being mainly attributed to inaccurate osteotomy cut and VS. Neighboring disc opening and rotational or translational subluxation were major available remedial mechanisms strengthening the lordosing effect when that of vertebral wedging was impaired and insufficient. The bone fusion and remodeling concerning the subluxated or dislocated osteotomized vertebra was utterly favorable, maintaining the kyphosis correction and preventing instrumentation failure.

Correction of Grade 2 Spondylolisthesis Following a Non-Surgical Structural Spinal Rehabilitation Protocol Using Lumbar Traction: A Case Study and Selective Review of Literature.

OBJECTIVE: Discuss the use of non-surgical spinal rehabilitation protocol in the case of a 69-year-old female with a grade 2 spondylolisthesis. A selective literature review and discussion are provided. CLINICAL FEATURES: A 69-year-old female presented with moderate low back pain (7/10 pain) and severe leg cramping (7/10 pain). Initial lateral lumbar x-ray revealed a grade 2 spondylolisthesis at L4-L5 measuring 13.3 mm. INTERVENTIONS AND OUTCOMES: The patient completed 60 sessions of Mirror Image® spinal exercises, adjustments, and traction over 45 weeks. Post-treatment lateral lumbar x-ray showed a decrease in translation of L4-L5 from 13.3 mm to 2.4 mm, within normal limits. CONCLUSIONS: This case provides the first documented evidence of a non-surgical or chiropractic treatment, specifically Chiropractic BioPhysics®, protocols of lumbar spondylolisthesis where spinal alignment was corrected. Additional research is needed to investigate the clinical implications and treatment methods.

Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report.

BACKGROUND: Pedicle screw instrumentation for treating spinal disorder is becoming increasingly widespread. Many studies have advocated its use to facilitate rigid fixation for spine; however, adjacent segmental disease is a known complication. Instrumented fusion for osteoporotic spines remains a significant challenge for spine surgeons. Prophylactic vertebroplasty for adjacent vertebra has been reported to reduce the complications of junctional compression fractures but has raised a new problem of vertebral subluxation. This case report is a rare and an extreme example with many surgical complications caused by repeated instrumented fusion for osteoporotic spine in a single patient. This patient had various complications including adjacent segmental disease, vertebral subluxation, and junctional fractures on radiographs and magnetic resonance images. CASE PRESENTATION: An 81-year-old Taiwanese woman underwent decompression and instrumented fusion of L4-L5 in Taiwan 10 years ago. Due to degenerative spinal stenosis of L3-L4 and L2-L3, she had decompression with instrumented fusion from L5 to L1 at the previous hospital. However, catastrophic vertebral subluxations with severe neurologic compromise occurred, and she underwent salvage surgeries twice with prolonged instrumented fusion from L5 to T2. The surgeries did not resolve her problems of spinal instability and neurologic complications. Eventually, the patient remained with a Frankel Grade C spinal cord injury. CONCLUSION: Adjacent segmental disease, junctional fracture, and vertebral subluxation are familiar complications following instrumented spinal fusion surgeries for osteoporotic spines. Neurologic injuries following long instrumentation are often serious and difficult to address with surgery alone. Conservative treatments should always be contemplated as an alternative method for patients with poor bone stock.

The influence of cervical spinal cord compression and vertebral displacement on somatosympathetic reflexes in the rat.

BACKGROUND CONTEXT: One theory within chiropractic proposes that vertebral subluxation in the upper cervical region induces spinal cord compression sufficient to alter spinal cord efferent output. We report on the feasibility of three different experimental approaches to test this theory. METHODS: A high threshold electrical-evoked somatosympathetic reflex was recorded in adrenal or renal nerves of 10 anaesthetized adult male rats before and after (1) graded pressure was applied directly to the C1/C2 spinal cord segment in eight rats by the use of either direct compression or inflation of an extradural balloon and (2) displacement, less than a dislocation applied posterior to anterior, to the C2 vertebra in two rats. The latency and amplitude of the pre- and postintervention reflex responses were compared. RESULTS: The reflex amplitude was not significantly changed by pressure (26 mmHg) from an extra-dural balloon or direct compression of the dura mater onto the dorsal spinal cord. Additional pressure, at least sufficient to occlude the dorsal vessels, induced a significant reduction in the amplitude of the reflex, and this reduction persisted for 20 minutes after removal of the pressure (Dunn's method for all pairwise multiple comparison Q stat=3.437; critical value for k=6 with α=0.05 is 2.936). Maximal vertebral (C2) displacement (4 mm), without dislocation did not induce significant changes compared with the control period. CONCLUSIONS: Although this feasibility study suggests it is unlikely that upper cervical vertebral subluxation, displacement less than a dislocation, compromises the sympathetic outflow in the adrenal or renal nerves, further vertebral displacement studies are necessary to formally test this.

Reliability of three methods of computer-aided thermal pattern analysis.

BACKGROUND: The objective of this study was to assess three methods of computer-aided thermal pattern analysis for a) examiner reliability, b) inter-method differences, and c) determine which method yields the highest percent-similarity between paired test-retest scans. METHODS: Three examiners compared two sets of thermal scans from the same 30 subjects using three different methods of scan alignment. The results were evaluated by the Intraclass Correlation Coefficient and the Wilcoxon signed-rank test, at the 5% level of significance. RESULTS: Intra and inter-examiner ICC scores for all methods were acceptable (> 0.75). There were no statistically significant differences (at the Bonferroni-corrected level of significance of 0.0004%) in percent similarity of the scans between the three methods CONCLUSIONS: The results contribute evidence to the reliability of TPC program software. Manually aligning the readings plays an important role in obtaining precise TPC percent-similarities.