Our time together today?

Clinical Concepts in the management of the Craniocervical Junction (CCJ) Vertebral Subluxation (part 1 of 4)Jeff Scholten, DC

Normal Anatomy

Clinician, Clinic Director, Owner – The Vital Posture™ Clinic – Calgary, Canada

Faculty – Life Chiropractic College West (Tech 333)

Instructor – Clinical Anatomy (DCCJP Program – ICA’s UCC)

President of the National Upper Cervical Chiropractic Association (NUCCA)

Vice-President of the RRGMF(Canada) (UCRF-C)

Board of the Upper Cervical Research Foundation (UCRF)

Past-President/ Board of the ICA’s Council on Upper Cervical Care (ICA-CUCC)

Credentialing Committee Chair ICA’s Council on Upper Cervical Care (ICA-CUCC)

University of Alberta

Post-Baccalaureate Graduate Certificate in Pain Management – (PgCPain) 2018

Council on Upper Cervical Care – International Chiropractic Association

Fellow in Chiropractic Craniocervical Junction Procedures – (FCCJP) 2016

Diplomate in Chiropractic Craniocervical Junction Procedures – (DCCJP) 2015

Palmer College of Chiropractic Doctor of Chiropractic – (DC) 2001

University of Calgary

Bachelor of Science, Kinesiology – BSc(KIN) 1997

Conflict of Interest

I have no financial interest in the subject matter or materials discussed in this presentation.

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Author: Lenz , Lenz

Title: The transverse occipital ligament: an anatomic, histologic, and radiographic study

Source: The spine journal [1529-9430] yr:2012 vol:12 iss:7 pg:596-602

Author: Tubbs RS

Title: Ligament of Barkow of the craniocervical

junction: its anatomy and potential clinical and functional significance.

Source: Journal of Neurosurgery: Spine [1547-5654] yr:2010 vol:12 iss:6 pg:619-622

Atlas MM’s

1. Levator Scapulae

2. Splenius Cervicis

3. Rectus Capitis Posterior Minor

4. Obliquus Capitis Superior

5. Obliquus Capitis Inferior

6. Rectus Capitis Anterior

7. Rectus Capitis Lateralis

8. Anterior Intertransverse

9. Posterior Intertransverse

10. Interspinalis

11. Longus Colli

Axis MM’s

1. Longus Colli

2. Middle Scalene

3. Levator Scapulae

4. Anterior Intertransverse

5. Posterior intertransverse

6. Interspinalis

7. Splenius Cervicis

8. Spinalis Cervicis

9. Longissimus Cervicis

10. Rectus Capitis Posterior Major

11. Obliquus Capitis Inferior

12. Semispinalis Cervicis

13. Multifidus

14. Rotator Brevis

15. Rotator Longus

Whiplash

Compression, Tension, Sheer all within 50-120 milliseconds.

“A 10 mile/hour collision is equivalent to catching a 200 lb bag of cement dropped from a second story window.”

Dr Scott Rosa

Whiplash Considerations

Ligaments

The ability, under physiologic loads, to limit patterns of displacement so as not to damage or irritate the spinal cord or nerve roots.

Newton’s of resistance

Abnormal

tectorial

membrane from

the literature

Normal tectorial

membrane from

the literature

(upper left

image depicted

by a single white

arrow).

Beighton’s score Joint Hypermobility

9-point scale

The joints assessed are:

1. Knuckle of the little/fifth/pinky finger

2. Base of the thumb

3. Elbow

4. Knee

5. Spine

Connective Tissue Disorder

Lateral Aperature

Median Aperature

Cerebellomedullary Cistern Cisterna Magna

Pontine Cistern

Quadrigeminal Cistern

Interpeduncular Cistern

Chiasmatic Cistern

Cerebral Subarachnoid Space

Dural Venous Sinus Review

Confluence of Sinus’

(located at Internal

Occipital Protuberance)

Created by:1. Superior2. Transverse3. Straight4. Occipital

6 paired1. Sigmoid2. Transverse3. Superior Petrosal4. Inferior Petrosal5. Cavernous6. Sphenoparietal

4 unpaired1. Superior2. Inferior3. Straight4. Occipital

CSF circulation

Influences

• Cardiac

• Respiratory

• Vasomotor (autonomic)

Systole (brainstem and CSF move caudally)

Diastole (brainstem and CSF move cephalad)”

What happens when the venous outflow backs up? Brain shrinkage?

Respiration

“CSF motion may be connected to breathing as well as heart rate

Coughing & Valsalva

• Valsalva causes caudal and then cephalad movement of CSF

• Coughing causes a cephalad movement of CSF”

(Whedon & Glassey 2009)

Vasomotor

“Traube-Herring Mayer (THM) (Vasomotor) waves • …generated by spontaneous pulsations of arterial, venous and lymphatic vessels.• …independent of the respiratory and cardiac cycles• …generally longer wavelengths than those of the respiratory and cardiac”

Lundberg, N. Continuous recording and control of ventricular fluid pressure in neurosurgical practice. EjnarMunksgaard; Copenhagen: 1960.

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