Upper Cervical Spine Kinematics and Central Nervous System Dynamics in Patients Presenting with Clinical Manifestations of the Upper Cervical Subluxation Complex

     Classically, chiropractors have described the mechanism of the upper cervical subluxation as dysfunction of the central nervous system (CNS) via compressive myelopathy resulting from osseous impingement of the spinal cord by the ring of atlas or axis. Accurate understanding of the anatomic and physiologic nature of upper cervical spine kinematics and its possible impact on CNS function aids the chiropractor in deciding which adjustive procedures are most appropriate as well as those which should be contraindicated. This hypothesis will be evaluated using precision radiology and high resolution MRI. Fifty patients exhibiting multiple signs of the upper cervical subluxation complex are to be evaluated for the presence of compressive myelopathy. The presence of the upper cervical subluxation complex will be confirmed after 2 blinded examiners performed a variety of commonly used specialized upper cervical clinical examination procedures. The presence or absence of compressive myelopathy will be determined by evaluation of 0.5 mm axial slices of the upper cervical region. Anatomic relationships will be evaluated in the neutral position as well as bilateral rotation in an attempt to visualize both the presenting abnormal kinematics and increased mechanical stress conditions. The MR images are to be evaluated by an independent neuroradiologist. This study is currently in progress.

Paraspinal Digital Infrared Imaging: An Inter and Intraexaminer Reliability Study

     Computerized infrared imaging is an accepted and reliable method of evaluating nervous system function. Extensive research has been performed using high resolution cameras. Recently, production of a hand held paraspinal infrared detection device (TyTron C-3000) engineered to the same standards as a camera detector, with regards to sensitivity and stability, has emerged. Bench testing using black body standards, performed prior to this study, yielded extremely high levels of inter and intraobserver reliability. This study was designed to test inter and intraobserver reliability under clinical conditions on human subjects. The examiners consisted of 3 doctors with various levels of experience (3 years, 1 year, 3 months) using this instrument on a daily basis. The variation in experience levels was added to determine if experience played a factor in interobserver reliability if any discrepancies were observed. Sixty randomized volunteers were examined by each doctor for a total of 540 collected images for statistical analysis. This study is currently in submission.

The Identification and Reliability of Osseous Landmarks Commonly Used in Upper Cervical Spine Roentgenometrics

     There has been much debate over the choice of osseous landmarks used for upper cervical roentgenometric analysis. Radiographic landmarks form the foundations of entire systems of analysis; hence their reliability is paramount to the accuracy of the evaluation. To evaluate the reliability of commonly used osseous landmarks, the vertebral segments C1, C2, and the skull in 15 different matched atlas/axis/skull sets were studied with one average set randomly selected for radiographic analysis. A qualitative visual analysis of the commonly used radiographic upper cervical osseous structures was performed on each set for symmetry. A quantitative study of the osseous structures was also performed using precision measuring instruments. A radiographic analysis of many osseous landmarks was also performed. The landmarks were identified by fixing wire of differing gauges to the structures and radiographing the area. Utilizing this methodology, common landmarks used for clinical radiographic mensuration by many upper cervical specialties were identified. The views taken were the APOM, nasium, and base posterior. The data collected was then used to evaluate the reliability of each of the selected landmarks for accurate roentgenometric evaluation. This study is currently being prepared for submission.

The Role of the Upper Cervical Spine in Managing Chronic Low Back Pain: An Outcome Based Study Utilizing Surface Electromyography and Paraspinal Digital Infrared Imaging

The Inter and Intraexaminer Reliability of an Upper Cervical Spine Roentgenometric System

     Precision radiographic analysis of the upper cervical spine has long been used by chiropractors who specialize in the correction of the upper cervical subluxation complex. However, any system of analysis that cannot be replicated by two different clinicians, or especially duplicated by the same doctor, leaves that system of analysis without reliability. This study is designed to evaluate the inter and intraexaminer reliability of a roentgenometric system utilized in an upper cervical chiropractic specialty (Applied Upper Cervical Biomechanics). One hundred sets of cervical radiographs (neutral lateral, AP, APOM, BP) are to be evaluated by 3 examiners with 20 years, 3 years, and 1 year of experience using this system respectively. Statistical analysis will be performed to determine levels of both aspects of reliability. This study is currently in progress.

Computerized Paraspinal and Camera Infrared Imaging: A Correlative Study in Paraspinal Thermal Detection

     In determining the reliability of diagnostic equipment, a comparison to a "gold standard" is commonly made. Currently, the gold standard in infrared imaging is the high-resolution digital camera system. This study was designed to investigate the correlation between the imaging capabilities of a handheld computerized paraspinal infrared system and a high-resolution camera. Experienced clinicians (more than 2 years of clinical use) in both the use of paraspinal and camera systems were used to perform the examinations. Sixty randomized volunteers were imaged by both types of thermographic systems under examination protocols set forth in the current indexed literature. A total of 240 scans will be independently statistically analyzed. This study is currently being prepared for submission.

The Effects of Cervical Spine X-Axis Rotation on the Dynamics of the Central Nervous System

     The potential for neurologic injury as a sequella to cervical acceleration/deceleration trauma has been well documented in the literature. There has been continued debate as to whether the most significant damage to the central nervous system occurs in the motion of hyperflexion or hyperextension. This study visualizes the dynamics of the central nervous systems via magnetic resonance imaging to provide information as to the potential for neurologic injury caused by these motions. Fifty volunteers will be examined by MRI with the cervical spine in neutral, full active flexion, and full active extension. The images are to be evaluated by an independent neuroradiologist. This study is currently in progress.

Symptomatology: A Retrospective Study of 1,000 Patient Case Results

     Many case studies, technique methods, and texts have been published on the specialty of upper cervical chiropractic. The literature has consistently delineated this specialty as one which produces consistent results on a multitude chronic and serious health conditions. As early as the 1930’s, research was begun in an effort to elucidate the mechanisms under which the upper cervical spine produces global physiological impact. Decades of study, combined with modern neurologic and biochemical research methods, have detailed the possible physiologic mechanisms under which the upper cervical specialty produces its effects on the body. This study is designed to investigate the results on 1,000 randomized cases from two outpatient practices using a unique upper cervical specialty (Applied Upper Cervical Biomechanics) exclusively. Selection will maintain that 70% of the cases be of patients presenting with primary organic complaints. This study is currently in progress.