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Major Models and Hypotheses of Chiropractic Subluxation: II. Neurologic Models

Major Models and Hypotheses of Chiropractic Subluxation: II. Neurologic Models. “…the central issues of chiropractic and “manual medicine” today concern the specific details of…neurological involvement [in the subluxation complex] rather than whether or not it exists.” Charles Lantz.

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Major Models and Hypotheses of Chiropractic Subluxation: II. Neurologic Models

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  1. Major Models and Hypotheses of Chiropractic Subluxation:II. Neurologic Models

  2. “…the central issues of chiropractic and “manual medicine” today concern the specific details of…neurological involvement [in the subluxation complex] rather than whether or not it exists.” Charles Lantz

  3. “Old Model” (Murphy) mechanical joint problem DJD radiculopathy and myelopathy

  4. “New Model” (Murphy) mechanical joint problem Chronically stressed tissues Afferent discharge Efferent reflex Efferent discharge Collagen breakdown DJD radiculopathy and myelopathy

  5. Three Types of Nerve Interference(Murphy) • Reflex • Irritation • Compression

  6. “New Model” (Murphy) mechanical joint problem Chronically stressed tissues Afferent discharge Efferent reflex “Reflex” nerve interference Efferent discharge Collagen breakdown DJD “Irritation” nerve interference radiculopathy and myelopathy “Compression”

  7. Major Neurological Theories(Haldeman) • Receptor stimulation • Nerve compression (traction) • Reflex effects • Supraspinal effects

  8. Skin Subcutaneous tissue Adipose Joint capsules Spinal ligaments Blood vessels Cancellous bone Periosteum Muscles Tendons Fascia Aponeurosis Dura mater Epidural tissue HYPOMOBILITY OF JOINTS HYPERMOBILITY OF JOINTS ALTERED BIOMECHANICS CELLULAR DAMAGE IN MULTIPLE TISSUE COMPONENTS OF MOTION SEGMENTS MUSCLE HYPERTONICITY INFLAMMATION INTRACELLULAR FLUIDS IN THE EXTRACELLULAR SPACE ***NOCICEPTOR STIMULATION (C-FIBERS) OF A CHRONIC NATURE SYNAPSE IN DORSAL HORN OF SPINAL CORD (ON POLYSYNAPTIC INTERNEURONS) PROGRESSIVE HISTOPATHOLOGY OF MULTIPLE TISSUE COMPONENTS OF MOTION SEGMENTS (DEGENERATION) ANTERIOR HORN CELL MULTIPLE EFFECTS (CENTRAL, AUTONOMIC) AFFECTING ENTIRE BODY Adapted from “Neurology of the Vertebral Subluxation” notes, Lisa Blooom, D.C., 2008

  9. Reference re: Neurologic Models: • Redwood & Cleveland, Fundamentals of Chiropractic, 2003 Chapter 8: “Neurobiologic Relations and Chiropractic Applications”

  10. From Owens et al, “Hypothesis Formulation for Scientific Investigation of Vertebral Subluxation,” JVSR, 3(3), 1999, p. 100

  11. II. Neurological Models • Nerve and Nerve Root Compression/Traction/Torsion aka “compressive neuropathy”

  12. Literature Review:J. Vertebral Subluxation Res., 4(2), 2001, pp. 37-48

  13. Nerve and Nerve Root Compression, Traction, and Torsion • IVF distortion due to VSC can cause mechanical compression of spinal nerves (“neural complex”) with resulting neurological injury and dysfunction • Other mechanical changes can cause traction and torsion injuries to the neural complex • “neurothlipsis”- pressure on a nerve, direct or indirect

  14. “To impinge upon a nerve is to press against it on one side. The impinging of nerves usually increases their function, because of irritation. Bones may be displaced, their projecting surfaces irritating the nerves which they strike against.” D.D. Palmer

  15. “If we will use the word impingement in the sense of pressure and remember that an impingement instead of squeezing or pinching a nerve only increases its tension by stretching, we will have an explanation which will explain; one which anatomists cannot gainsay.” D.D. Palmer

  16. “…nerves may be subject to stretch, constriction, compression, torsion, angulation, and ischemia.” “The predominant consequence of the more common and more subtle deforming forces…is…not the loss of excitability, but, on the contrary, hyperexcitability and the hyperirritability syndromes that it engenders.” Irvin M. Korr, PhD

  17. Lateral horn Dorsal root ganglion (DRG) Dorsal root Dorsal horn IVF region Spinal nerve Ventral root Anterior horn

  18. “…Hadley found evidence that cervical and lumbar subluxations could produce foraminal encroachment that would cause or at least predispose the spinal nerve roots to compression. He also found that intervertebral subluxations could cause foraminal encroachment in the thoracic spine, but he determined that nerve root compression would be unlikely there due to the smaller diameter of the nerve roots.” Leach, The Chiropractic Theories, p. 53

  19. “…the only postmortem studies available indicate that subluxation is a factor in the compression of nerve roots and that the subsequent pathology depends on the severity of the compression. Pathophysiological features at the site of subluxation might include demyelination and degeneration of an individual fiber or groups of fibers, edema of the endoneurium, sclerosis of arterioles within the nerve bundle, and damage to the spinal ganglion itself.” Leach, p. 57

  20. “Any abnormal constriction in the size of a normal intervertebral foramen if not actually causing nerve root pressure, nevertheless decreases the reserve safety cushion space surrounding that nerve and may predispose to pressure.” Hadley

  21. Nerve Compression factors: • Subluxations cause spinal nerve root compression and injury (Hadley)

  22. Nerve Compression factors: • Nerve roots are susceptible to compression (Gelfan, Tarlov, Sharpless)

  23. Nerve Compression factors: • Nerve roots and sheath occupy 35-50% of IVF cross-sectional diameter; remaining 50-65% is loose areolar connective tissue, adipose, other vascular and neural structures

  24. Nerve Compression factors: • Nerve roots lack the connective tissue sheath of peripheral nerves

  25. Nerve Compression factors: • Spinal distortion may displace neural complex laterally into the IVF by traction

  26. Transforaminal Ligaments (TFL’s) • “accessory ligaments”; found to be normal occurrences throughout the spine; locations variable in the IVF • Especially common in lumbar spine- several at each level; L5-S1 very prevalent • They compartmentalize the IVF into a lattice that vessels and nerves must thread through • May decrease the functional S to I diameter of the IVF by one-third

  27. Most Common Locations of Transforaminal Ligaments (TFL’s) in the IVF Vertebral pedicle Mixed Spinal Nerve in Dural Sleeve TFL’s Vert. Body 1 Vein Artery IVD Recurrent Meningeal Nerves Vert. Body 2 Z-joint Vertebral pedicle Lymphatic vessel

  28. Ectopic Impulse Hypothesis (Korr) • Deformation sites (as in the case of neurologic compression in the IVF) can be sites where ectopic nerve impulses are generated • These are spontaneous depolarizations that give rise to both orthodromic (proper direction) and antidromic (wrong direction) impulses • These have different effects if the involved nerves are sensory or motor

  29. Ectopic Nerve Impulses from Compression/Deformation Motor Nerve: Antidromic impulses orthodromic impulses Deformation Site (MUSCLE) Sensory Nerve: orthodromic impulses Antidromic impulses (SENSE ORGAN) Deformation Site

  30. Ectopic Impulse Hypothesis (Korr), cont.: • Lateral transmission (ephaptic transmission, or “cross-talk”) can also occur at the deformation site • The small electrical field changes that accompany a normally-propagated impulse can cause depolarization of adjacent axons at the deformation site; again, antidromic and orthodromic ectopic impulses are generated

  31. II. Neurological Models • Nerve and Nerve Root Compression/Traction/Torsion aka “compressive neuropathy” B. Dorsal Root Ganglion compression/irritation

  32. Dorsal Root Ganglion Compression • Mechanical stresses due to VSC can cause injury to the highly sensitive DRG • DRG are far more sensitive to mechanical stimulation than peripheral nerves (5X more sensitive to compressive forces) • When inflamed, DRG become hyperexcitable, and can give rise to spontaneous discharges • A significant irritating factor can be injury/inflammation/swelling in Z-joints

  33. Lateral horn Dorsal root ganglion (DRG) Dorsal root Dorsal horn IVF region Spinal nerve Ventral root Anterior horn

  34. Other Direct Mechanical Effects to Nerves: “Sympathetic nerves and ganglia can be directly impinged by osteophytes extending from the spine. As rigid extensions from the vertebrae, a claw spur reaching the vicinity of the sympathetic chain perturbs it as motion occurs.” Triano, in Haldeman, Principles and Practice of Chiropractic 1992, p.254

  35. Dorsal root DRG Spinal Nerve Ventral root Sympathetic Chain Ganglion

  36. CervicalSpineNeuroanatomy

  37. “There is evidence of nerve compression at the level of the IVF occurring anywhere from 15.4% to 78% of levels inspected.”

  38. “Pressures as little as 10 mm Hg can alter the nerve root and dorsal root ganglion’s ability to function normally. In the normal range of motion the pressures generated in the IVF may exceed 30 mm Hg.”

  39. “The concept that a vertebral subluxation can produce pressure increases at the level of the IVF is supported by the literature. This increase, however mild, is enough to alter nerve function.”

  40. “The garden hose theory or hard bone - soft nerve explanation of vertebral subluxation is considered by some to be archaic but appears to be a valid entity at least in the lower cervical spine.”

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