bnsdcMemberApril 24, 2012 at 2:12 amPost count: 1
I am a chiropractor and mother of a 7 year old boy with instability of C2. In a neutral lateral view, his spine is well aligned with normal lordosis. In flexion, I see slightly greater than 25% anterior translation(4mm)of C2 on C3.
He does not usually complain of neck pain.
He does have chronic headaches but these have improved significantly after removing food allergens from his diet.
He has a habit of putting his neck into repetitive extension (almost a pumping motion) which often ilicits a large audible “clunk” sound.
He has a history of trauma (3 years ago) when he fell off of playground equipment and landed on his head/neck. We did not see the position in which he landed. He had significant pain at the time and could not bear the weight of his head. Xrays at Children’s hospital were negative, however, they were taken with him a cervical collar. He has had smaller falls/head trauma involving sports since then.
Our plan at this time is to manage this conservatively with therapeutic exercise to strengthen and stablize the cervical spine as well as to supplement nutritionally with Liagplex II from Standard Process.
Our questions are:
Do you think this is an appropriate plan?
Is there anything you would add?
Have you seen any form of strengthening/stablizing exercises be more effective than others?
Is there any additional testing you would recommend?
When should we repeat the xrays to evaluate progress?
Is there a need for neurosurgical consult at this time?
What is the likelihood that we will see the instability resolve?
The answers to these questions as well as any other thoughts you have are greatly appreciated.
Thank you for your time.Donald Corenman, MD, DCModeratorApril 24, 2012 at 4:52 amPost count: 8583
In children, a condition occurs called pseudosubluxation of C2 on C3. This is due to two circumstances. One is that the osseous structures have not fully formed and the cartilaginous structures do not show up on an X-ray film (the facets are less angulated than the adult). In addition, the ligaments are more lax than in an adult. Subluxation of 4mm is within normal limits for a child.
If he does not complain of significant neck pain, the popping is probably a facet suction release as is the typical chiropractic adjustment.
I cannot comment on Ligaplex II as it has been a long time since I reviewed Standard Process products.
Generalized strengthening maneuvers would be a good idea but do not load the neck with weights at this time. He is simply too young with open growth plates.
Since the X-rays are within normal limits, I would just follow him listening to his complaints only as no further X-rays are necessary in regards to C2-3.
Dr. CorenmanPLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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