[

-I

_ READ BY CHIROPRACTORS AROUND THE WORLD

THE MAGAZINE THAT REFLECTS THE LIFE PRINCIPLE IN CHIROPRACTIC

11:1

ChiropracticAnd The

VertebralArteries

Roy W Sweat, D.C.

Roy W. Sweat, D. C.Thomas Sievert, D.C.

About theAuthor:Dr.Roy W Sweat'spractice is in Atlanta, Georgia.He isa graduate of Palmer College. In1952, he began a course of studyspecializing in the upper ceroicaloccipital-atlanta-axialcomplex underDr.John F.Grostic.Dr.Grosticchosehim as an instructor at hisseminars. Sweat completed a three-year program in chiropractic ortho-pedics from the National Collegeand is an associate professor at LifeCollege.

Dr. Sweat designed the ceroicalanalysis instrument. In 1981 hecreated the program of chiropracticAtlas Orthogonality and wrote aseries of five books. Dr. Sweat hasdesigned a chiropracticadjusting in-strument and also a series of x-raymachines and the orthogonaladjust-ing tables.

About the Author: Dr. ThomasSievert attended the University ofWisconsin at Eau Claire, and grad-uated magna cum laude from LifeChiropractic College. Dr. Sievert in-terned under Dr. Roy Sweat fromwhom he received special training inorthogonal procedures of ceroicaladjustment He also has done postgraduate work in orthopedic testing,personal injury and impairment rating.Dr. Sievert is a diplomate of theNational Board of Chiropractic Ex-aminers. He maintains a practice at2060 Collier Avenue, Fort Myers,Fla., 33901.

Today's Chiropractic/September-October. 1984

Ti he fundamentals of the chiro-practic profession are based

I on vertebral and osseousinvolvements producing

neurological insult and disease. Nowwe have a circulatory fundamentalwith vertebral and osseous involve-ment producing vertebral artery insultresulting in ischemia, causing neuro-logical deficit and disease. A variety ofdiseases, maladies and symptomaticcoriditions, in which the chiropracticprofession has achieved outstandingsuccess and miraculous results, cannow be documented by the medicalprofession as related to vertebral arteryinsult.

Central peripheral nervous systemdysfunctions due to vertebral arterycompromise have been described byresearchers to occurfrom degenerative,traumatic, and kinematic effects, andfrom subluxations of the cervical spine.These findings broaden the spectrumof chiropractic treatment to providefor the removal of vascular compromiseas well as neurological insult. Thiscurrent evidence is an important ex-planation of the effectiveness of chi-ropractic care for the treatment ofcranial nerve, brain stem, cerebellum,and posterior cerebral functionaldisorders.

The vertebral artery is the majorsource of blood supply to the cervicalspinal cord and brain stem which in-cludes the medulla oblongata, pons,and mid- brain. It also supplies thevisual cortex of the cerebrum and thecerebellum via the basilar artery.Compression of the vertebral arteryhas been noted by numerous author-ities and is reported to produce abizarre variety of symptoms resultingfrom ischemia. Minor compromise ofthe arterial blood flow is characterizedby Barre'-Lieou syndrome. Severe

Part One of Two

kinking of the vertebral artery mayresult in the formation of a throm-bosis that may extend superiorly andoccludethe posteriorinferiorcerebellarartery producing Wallenberg's syn-drome.Review of Literature

Hadley states, "The vertebral arteryis an important link in the collateralcerebral blood supply. The symptomsconstitute a most bizarre and confusingclinical picture, which has been de-scribed as the Barre'-Lieou syndrome.They include: headache, vertigo,nausea, vomiting, nystagmus andsuboccipital tenderness."

In their book titled, The CervicalSpine, published by the Cervical SpineResearch Society of the medical pro-fession, Ian MacNab states, "Minordegrees of vertebral artery com-promise may be responsible for theso-called vertebral artery syndromeconsisting of dizziness, tinnitus, inter-mittent blurring of vision and occa-sional episodes of retro-occular pain.Occasionally, a neurocentral osteo-phyte may produce severe kinking ofthe artery, resulting eventually in avertebral artery thrombosis that mayextend superiorly and involve theposteroinferior cerebellar artery. Oc-clusion of this artery leads to the de-velopment of the Wallenberg's syn-drome, which is associated with thefollowing symptom complex.

1. Dysphagia, ipsilateral palatalweakness, and vocal cord paralysisfrom involvement of the nucleus am-biguous of the vagus.

2. Impairment of sensation to painand temperature on the same side ofthe face from involvement of thedescending root and nucleus of thefifth nerve.

3. Homer's syndrome in the homo-lateral eye from the involvement of

Oph1hMo..

III

IV

Inf. pe1rOS8l sinus

VIII

----

Vertebral arteriogram (lateral projection)

Composite drawing of the vertebral-Basilar arteries and Circleof Willis

the descending sympathetic fibers.4. Nystagmus due to the involve-

ment of the vestibular nuclei.5. Cerebellar dysfunction in the

ipsilateral ann and leg from interfer-ence of the function of the midbrainand cerebellum.

6. Impainnent of sensation to painand temperature on the side of thebody opposite from the involvementof the spinothalamic tract.

Epstein states, "Spondylotic deform-ities may impinge on the foraminatransversaria and cause compressionof the vertebral artery, thereby pro-ducing a clinical syndrome of vascularinsufficiency with headache, vertigo,visual and speech defects and gaitimpainnent"

Von Torklus states, "Vascular dis-turbances (irritation of the vertebralarteries and the posterior cervicalsympathetic plexus, commonly re-ferred to as vertebralis syndrome cancause occlusion of the venous orcerebrospinal fluid circulation."

Kabat states, "Decreased blood flowin the basilar artery and the resultingischemia of the brain stem, cerebellumand visual cortex produces a form ofbasilar artery syndrome. More com-

Today's Chiropractic/September-October. 1984

mon complaints from compression ofthe vertebral artery are vertigo, syn-cope and nausea. Infrequent symp-toms from such compression of thevertebral artery include impairmentof vision, diminished sensation in theface, intention tremor or ataxia, anddysphagia. These different complaintsusually occur singly but may appeartogether. Vertigo from compressionof the vertebral artery is the result ofischemia of the brain stem affectingvestibular function. Diminished sen-sation in the face, usually unilateraland localized to the lips or around theorbit, is another manifestation ofcompression of the vertbral arteryproduced by ischemia of the sensorynucleus of the fifth cranial nerve in thepons. Light-headedness or feelingfaint may be caused by compressionof the vertebral artery. Compressionof the vertebral artery produces ische-mia of the brain stem affecting thefunction of the vomiting center."

Rotham and Simeone state,"Children with occipitocervical ano-malies may be more susceptible tovertebral artery injury and brain stemischemia, particularly those who under-go skull traction for correction of

.-

scoliosis. Even moderate amounts oftraction (less than 15 pounds) thatnonnally would be well tolerated maycompromise these abnormal vessels.Although this condition is congenital,many patients do not develop symp-toms until the second or third decadeof life.

Similarly, arteriosclerotic changesin the vertebral arteries may makethese vessels more susceptible to minoror temporary constrictions that wouldgo unnoticed and may later causeischemia or infarction. The symptomsfrequently occur in older patients inwhom congenital anomaly would notordinarily be considered. Patientswith this malformation have beenmistakenly diagnosed as having mul-tiple sclerosis, posterior fossa tumors,amy trophic lateral sclerosis or trau-matic injury. Blurring of vision, inter-mittent blurring of vision of shortduration, tinnitus, buzzing in the earsor a "plopping" sensation and dizzi-ness, early severe vertigo may becaused by a temporary shutoff of thevertebral arteries. The vertebral arteriesmay be compressed in chronic cervicaldisc disease by three mechanismsthat are obvious when one considersthe anatomic confines of the foramentransversarium in vertebrae C2 throughC6 through which the vertebral arterypasses. These are (1) osteophytes fromthe lateral portion of the disc margin;(2) osteophytes extending anteriorlyfrom the zygapophyseal joint and (3)compression by the inferior articularfacet from posterior subluxation with

47

scissoring action by the adjacentsuperior articulating facet."

White and Panjabi state, "There isextensive axial rotation between Cland C2. Studies have shown that 50per cent of axial rotation in the neckoccurs at CI-C2 and that the remainderoccurs at the joints of the lower cervicalspine. The extensive amount (47°) ofaxial (y-axis) rotation at CI-C2 cansometimes cause clinicalproblems withthe vertebral artery. Symptoms ofvertigo, nausea, tinnitus and visualdisturbances may occur from occlusionof the vertebral artery associated withaxial rotation of the atlas."Anatomy of theVertebral Arteries

The vertebral arteries arise fromthe subclavian arteries and run pos-teriorand cephaladbetweenthe longuscolli and scalenus anterior musclesentering the transverse foramen ofC6 and followan almostverticalascentthrough the alignedcervicaltransverseforamenuntiltheyreach the transverseprocess of C2, which projects pos-terolaterally and 25 degrees to 45degrees caudally compared to theanterolateraland horizontalprojectionof the lower cervical vertebra. Fromthe transverse of the second' cervicalvertebra to the occiput, the vertebral

Posterio~cerebra.~ ~artery

Basilar !artery

Anterior inferiocerebellar artery

Posterior inferiorcerebellar artery

Vertebral arteriogram (a.p. projection)

artery makes four right angle turns inthe area of 20 millimeters to 30millimeters.

Hadley reports the firstright angleturn to occur posterior and lateralwithinthe transverseofC2.The secondturn occurs as the artery exitsfrom thetransverse foramen of C2 bendingcephalad to the transverse of Cl,forming a loop. as the artery passesthrough the Cl transverse process, itabruptlyturns posterior and continuesalongthe upper surfaceofthe posterior

'osteriorpericallosalartery

uperiorcerebellarartery

nterior inferiorcerebellar artery

Posterior inferiorcerebellar artery

Vertebral artery

arch of the atlas vertebra, completingthe third right angle turn. The finalturn occursas the arterycurvessharplyaround the posterior aspect of thelateral mass of the atlas and ascendsanteriorly to enter the foramen mag-num. Vertebral arteries are moresubject to insult when they bifidate ormake a sharp angle turn. It should benoted that"CIBA"depictsthe vertebralartery running vertically from C6 tothe Cl transversewithoutthe twolowerloops. Continued next issue

- -.

I