Cervical spine and architecture biomechanics

Cervical spine biomechanics and applied aspect

1. Looking cervical spine in retrospect Prof .(Dr) B.C.Mohanty 3 rd .Aug. 2024

2. Normal curvature of spine in biped & quardriped kyphotic curve in cervical spine . A  reverse curve , and this involves the vertebrae in the neck’s curve bending in the wrong direction , becoming more  kyphotic  than  lordotic Eur Spine J.  2011 Apr; 20(4): 523–536

3. Snakes have to make curve in attempting erect posture

4. Embryological back ground of C.L. In 1977, Bagnall et al 9  found that at 9.5 wk of gestation, 83% of fetuses had C.L., 11% had a military configuration, and only 6% of fetuses had cervical kyphosis . Hence authors deduced that 94% of fetuses began to use their posterior cervical muscles to form cervical curve by 9.5 wk of gestation. In infancy at 3rd- 4th .Months attempt to lift wt. of head gradually establishes C .L .

5. Normal curve of spinal column Cervical lordosis : 20 to 40 degrees Thoracic kyphosis : 20 to 40 degrees Lumbar lordosis :  40 to 60 degrees

6. Bio-mech. of C . Sp. In 2005, McAviney   et al . study in 300 cervical X-rays with and without cervical pain. They found “ a statistically significant association between cervical pain and lordosis of c. sp.<20° .”  

7. Types of reverse cervical curve A: Normal “C” cervical lordosis : normal cervical curve with lordosis . B: Hypolordosis : loss of optimum curvature, but still lordotic C: Military: complete loss of lordosis resulting in a straight spine D: Hypokyphosis : “R” reversed curve, a slight flexed posture of the cervical curve. E : Degenerative hyperkyphosis : extreme reversal of cervical curve (sideways “V”). F: Sigmoidal “S ” https://www.caringmedical.com

8. Lateral view of cervical spine of deferent curve

9. Grossly 4 types of cervical curvatures

10. General function of the cervical spine Bears the weight of the head in erect posture( Provides cushioning effect in jerks Provides mobility , flexion /extension/ lateral flexion & rotation Protects spinal cord/nerve roots / vessels’ like vertebral artery

11. General function of the cervical spine Bears the weight of the head in erect posture Provides cushioning effect in jerks Provides mobility , flexion /extension/ lateral flexion & rotation Protects spinal cord/nerve roots / vessels’ like vertebral artery

12. usual causes of cervical kyphosis : Degenerative disc disease , a condition in which the discs between vertebrae wear down Ankylosing spondylitis , a disease where vertebrae fuse together. Congenital Spinal abnormalities present at birth. Spine tumors . Trauma or injury of the  spine . Prior spine surgery .  . Albert TJ, Vacarro A. Postlaminectomy kyphosis .  Spine.  1998;23:2738–2745. doi : 10.1097/00007632-199812150-00014 Steinmetz MP, Stewart TJ, Kager CD, Benzel EC, Vaccaro AR. Cervical deformity correction.  Neurosurgery.  2007;60( Suppl 1):S90–S97

13. Modern life style & loss of cervical lordosis 1 Tech neck , (desktop, mobile use) hours after hours Uneven weight distribution ( carrying weight Exa . bag on one shoulder) 3 Faulty posturing 4 presence of scoliosis (condition involves an unnatural sideways spinal curve, with rotation

14. Habit of neck flexion in modern life

15. Modern habits changes the physiology In a previous study, it was reported that prolonged screen view has association with increased neck and head flexion posture in children , especially in a sitting position [ 9 ]. ].

16. Effect of prolonged flexion of neck Now a days a normal cervical lordotic curve number is declining; even pre- adolescent children have straight curves because of all the time looking down while are playing games on their smart-phones or tablets .

17. Effect of C . Spondylosis on physio pathology C . Spondylosis has 3 stages (A) dysfunctional stage, (B) unstable stage, (C)stabilization stage [ 63 (A) Repitted trauma rotational strain or,with compression injury to the facet joints compromise the capsular ligaments & capsular ligament injuries cartilage degeneration and synovitis capsular laxity occurs. This stretching response can cause cervical instability, marking the (B) unstable stage . (C ) stabilization phase occurs with the formation of marginal osteophytes bony deposits can lead to a natural fusion of the affected vertebrae [ 64 ].

18. On chronic neck flexion attitude . Facet joint degeneration-An initial procedure of the cervical spine degeneration JOR Spine 2023 Jan 2;6(1):e1241.   doi : 10.1002/jsp2.1241.  eCollection 2023 Mar Damaged ligaments and atrophied muscles cause hypermobility of the cervical spine vertebrae . These Floating vertebrae leads to pinche nerves, arteries, & veins .

19. On chronic, prolonged flexion of neck . Results in . Stretched ligaments Over the time the CREEP phenomena which is a degenerative condition brought on the ligaments by wear and tear from the head down work (computer) or chronic cell phone use (Ligament Creep cause a chronic cycle of neck pain, headache ) As ligaments become weaker, as the head-forward position increases . The weakened ligaments fails to keep the cervical vertebrae in proper alignment. Increasing load falls on muscles to limit the ROM at the failure of ligaments Ligament structure, physiology and function Journal of Musculoskeletal and Neuronal Interactions https://www.ismni.org › jmni › pdf › 21FRANK ↓ Muscle develop spasm and chronic unfamiliar work lead to neck muscle atrophy.

20. March of events following affection of ligaments The capsular ligaments & muscles in the occipto-atlantal joint function as joint stabilizers and can also become injured due to excessive or abnormal forces [ 46 ]. Excessive tension on the capsular ligaments can cause upper cervical instability and related neck pain [ 56 Capsular ligament tension is increased during abnormal postures, causing elongation of the capsular ligaments, with magnitudes increased by up to 70% of normal [ 57 ]. . Therefore, capsular ligament injury appears to cause upper cervical instability because of laxity in the stabilizing structure of the facet joints [ 58 ]. While disc herniation can easily be seen on routine (non-functional) MRI or CT scans, but not the evidence of radiculopathy from cervical instability.

21. Biomechanics of the Cervical Spine cervical spine is a w As per cartesian coordinate eight-bearing mechanical structure with 6 . degrees of freedom of movement . cervical spine is a weight-bearing mechanical structure with 6 degrees of freedom of movement

22. Bio-mech. C .Sp. The principle motions of the cervical spine include flexion/extension, axial rotation and lateral bending, along with a small amount of coupled anterior/posterior translational & has movements along the Cartesian coordinates The cervical spine is able to move within the neutral zone (NZ) with relatively little force, therefore requires very little energy expenditure from the para -spinal muscles

23. Biomech.of LOCL . The cervical spine is able to move within the N Z with relatively little force, An abnormal increase in NZ or, ROM may indicate ligamentus injury or spinal instability Neurospine .  2020 Dec; 17(4): 833–842. Published online 2020 Dec 31.  doi :  10.14245/ns.2040524.262

24. Basic physical parameters that dictate the biomechanical properties of the cervical spine wt. of head is the mass (m ), force (F) , standard gravity (g) , moment arm (L), bending moments (M), and instantaneous axis of rotation (IAR). In the upright position, the magnitude of gravitational force of head on C.spine is , F = m × g. This force then creates a forward bending moment M around a fulcrum of IAR . The magnitude of the bending moment is M = F × L , in which L is the distance between the IAR and the Center of gravity line. In Normally aligned lordotic cervical spine, the posterior tension band and paraspinal muscles counterbalance the forward bending movement created by the weight of the head with little effort

25. Biomech . Of C .Sp. When cervical kyphotic deformity is present, the head COM ( Center of Mass)moves anteriorly and the movement arm L increases relative to the IAR, thus creating a larger bending moment - M .----- as M = F x L The resultant larger bending moment M requires greater paraspinal , muscle contraction to keep the head erect. which in turn can cause muscle fatigue and pain. In addition, kyphotic cervical deformity shifts the axial load anteriorly , This accelerate cervical disc degeneration . Disc height from degenerative changes can cause C. K. thus creating the notion more “ kyphosis begets kyphosis ”

26. Biomechanics of LOCL With LOCL the axial load is shifted anteriorly Extensor muscle neck remain in extra tension in order to provide horizontal gaze. The mechanical stability of C. Sp. is provided by the neck musculature (80%) & the oseo-ligamentous system (20%). Panjabi etal 1998 Weakness of the cervical muscles may bring about the mechanical instability of cervical spine & leads to L O C L With LOC L Pt. develop weak neck extensor > flexor . associated with chronic neck pain (Cheng et al., 2014

27. Biomech of cervical sp. Effect on the vertebrae Vertebral bodies (VBs) of C2–C7. VBs that primarily resist compressive forces bear approximately 36% of the axial load. Posterior natural structures ( fasets ) resist tensile forces & bear approximately 64% of the axial load . “The verebral stability of spine” Spine 1988 GP Sherk ( P- 447-449) So on C.K. the Anterior part of body has to bear more weight which accelerates process of degeneration locally.

28. Clinical instability in spine White and Panjabi defined clinical instability of the spine as the loss of the spine's ability to maintain its patterns of displacement under physiologic loads so there is no initial or additional neurologic deficit, no major deformity, and no Incapacitating pain . That is when RMO & NZ during instability What Is Cervical Instability? Cervical instability , also called clinical instability of the cervical spine (CICS), refers to a condition in which the ligaments of the cervical spine become loose or overstretched, allowing an abnormal range of movement (or neck hypermobility ) which causes  spinal misalignment  and neck instability .

29. L O C L causes disruption in biomechanics of the cervical spine study of Hansraj [ 5 ] in 2014, when the neck is bent at 15°, 30°, 45°, and 60°,fom nrmal the cervical spine receives approximately 3, 4, 5, and 6 times more weight The axial load is shifted anteriorly as lordosis is lost , and the increased compressive forces can trigger a progressive degenerative process resulting in cervical kyphosis (Ferrara, 2012; Harrison et al., 2001; Tan et al., 201 5) Hence the weakness of the cervical muscles may bring about the mechanical instability of cervical spine, contributing to L O C L

30. LOCL & its effect on the balancing system

31. LOCL effect on cervical muscles It is suggested that the loss of cervical lordosis may be associated with abnormalities in cervical muscular contractions, such as reduced muscle activation of the upper trapezius and rhomboids , and it may also provoke overfiring I Journal of Manipulative and Physiological Therapeutics Volume 28, Issue 3 , March–April 2005, Pages 187-193

32. EMG of Neck muscle Location of S-EMG electrodes for both trials ( A ) First trial (Ch 1, 2: bilateral splenius capitis , Cha 3, 4: bilateral lower semispinalis cervicis , Ch 5, 6: bilateral sternocleidomastoid , Ch 7, 8: Bilateral upper trapezius / levator scapulae muscles) ( B ) Second trial (Ch 1, 2: bilateral upper splenius cervicis , Cha 3, 4: bilateral upper semispinalis cervicis , Ch 5, 6: bilateral lower splenius cervicis , Ch 7, 8: Bilateral middle trapezius / rhomboid muscles). 

33. EMG Suggests Conclusions LOCL may be associated with abnormalities in cervical muscular contractions, reduced muscle activation of the upper trapezius and rhomboids, provoke over firing in the upper trapezius muscle.

34. Effect of LOCL on sp. column. when one spinal section loses a healthy curve, a compensatory curve develop in adjacent section in an attempt to counteract the adverse spinal tension introduced by the first unnatural curve [https://www.scoliosisreductioncenter.com/blog/loss-of-cervical-lordosis When in the cervical spine L OCL develops , Thoracic spine becomes straighter , introducing more abnormal spinal curvature as a compensatory phenomenon. . Ames et al. [ 3 ] have reported that pelvic incidence (PI) is correlated with lumbar lordosis (LL), LL is correlated with thoracic kyphosis , and thoracic kyphosis is correlated with cervical lordosis (CL). Also reverse do occur.

35. Effect of LOCL on spinal column . Cont. When the spine loses its lordosis or, kyphosis ,, or both, it can become unnaturally straight and disrupt the spine’s biomechanics; this is known as  straight back syndrome . (When sternum to mid bodyD8 distance <11-12 CM & Cardio thoraacic ratio <.5 St. Back syndrome presents with Painful back muscles Mobility restrictions Fatigue A feeling of falling forward A pronounced stoop at the end of the day

36. LOCL on C.V.& Resp. system ( straight back syndrome) center of gravity shifts forward. feeling of falling forward on walking or standing. Initially to compensate for the altered balance of the spine. The back muscles contract to pull the spine back to stand straight . commonly associated with mitral valve prolapse and bicuspid aortic valve disfunction . Palpitations . Arrhythmias Mostly asymptomatic ,if symptomatic, chest pain and palpitations are most common . Back pain. Shortness of breath .   Asian Cardiovasc Thorac Ann . 2016 Jan;24(1):63-5.   doi : 10.1177/0218492314539335.  Epub 2014 Jun 6 .

37. Symptoms of straightening of neck 1.Neck pain : This is the most common symptom. The pain might be dull or sharp, and it can range from mild to severe. It may be constant or intermittent. 2.Stiffness : The neck might  feel tight and less flexible , making it difficult to move or turn the head. 3.Headaches :  Tension-type headaches  or occipital neuralgia might occur, especially at the base of the skull. 4.Muscle spasms : The  muscles in the neck may frequently spasm  or feel tense, leading to further discomfort. 5.Numbness or tingling:  Altered cervical alignment can lead to nerve compression, causing sensations like numbness,  tingling , or even weakness in the arms. 6.Decreased range of motion : Turning the head side-to-side or tilting it up and down might be limited. 7.Shoulder pain : Pain may radiate or refer to the shoulder areas.

38. .   Symptoms of straitening of neck cont. 8.Radiating pain : In some cases, pain can radiate down to the arms and hands, a symptom commonly referred to as   radiculopathy . 9.Postural changes : Individuals might notice a forward head posture , where the head is positioned more forward relative to the shoulders. 10.Fatigue : Continuous pain or discomfort can lead to  fatigue   or general tiredness 11.Vertigo or dizziness : Though less common, some individuals may experience  vertigo  or dizziness related to neck issues. 12.Difficulty swallowing or breathing : In extreme cases, if there is significant compression or changes in the structure, there might be difficulties in swallowing or breathing. This is rare but can be a sign of a more serious condition. 13.Visual disturbances : In rare cases, altered cervical alignment can lead to visual symptoms.

39. Cervical pain According to the International Association for the Study of Pain (IASP), cervical spinal pain defined as arising from anywhere within the region bounded superiorly by the superior nuchal line, inferiorly by an imaginary transverse line through the tip of the first thoracic spinous process, and laterally by sagittal planes tangential to the lateral borders of the neck” Chronic neck pain may increase the transmitter activity of neuropeptides in the upper cervical medulla causing impairment of the blood flow in the local muscle because of a lack of vasodilatatory substances excreted axonally . pain and tightness can cause spasms of the arteries around the nerves of the neck and head. 20 Feb 2018 Don't Let Neck Pain and Headaches Hold You Back MTI Physical Therapy https://mtipt.com › Health Blog

40. . Effect on spinal cord These kyphotic deformity can also lead to stretching and lengthening of the spinal cord, resulting in increased tension and impaired microcirculation , eventually leading to spinal cord ischemia and resultant myelopathy over time. However, not all kyphotic deformities are symptomatic. It has been estimated that cervical kyphosis can be found in 2% to 35% of asymptomatic patients. 6–8

41. Effect of Cervical instability When the soft tissue of the cervical spine is damaged, weakened, lax, loose, and degenerating, the bones of the neck wander around. narrowing of the inter-vertebral neural foramina space, the extent of which can reach the critical point at which the nerve is compressed ( radiculo-pathy ) or the spinal cord is compressed ( myelo-pathy ). narrowing can also decrease or compress the flow of fluid ( Arterial ,Venous & C S F flow ) 

42. Effect of LOCL on sp.cord -cont. There was a significant correlation between the kyphotic angle and the degree of spinal cord flattening . The spinal cord was compressed most intensely at the apex of the kyphosis , where demyelination of the anterior funiculus as well as neuronal loss and atrophy of the anterior horn were observed . Demyelination progressed as the kyphotic deformity became more severe, initially affecting the anterior funiculus and later extending to the lateral and then the posterior funiculus . Angiography revealed a of the vascular distribution at the ventral side of the compressed spinal cord. Progressive kyphosis of the cervical spine resulted in demyelination of nerve fibers in the funiculi and neuronal loss in the anterior horn due to chronic compression of the spinal cord and focal ischemia Spine  30(21):p 2388-2392, November 1, 2005.

43. Effect of kyphosis on spinal cord . The spinal cord may be “draped” over the dorsal aspect of the VBs at the apex of the kyphotic deformity , in the so-called “ bowstring effect ” ; the cord shifts anteriorly to the anterior portion of the spinal canal and becomes tethered by the dentate ligaments with the progression of CK. mechanical stress on the spinal cord may result in microvascular compression and ischemia   Masini M, Maranhao V. Experimental determination of the effect of progressive sharp-angle spinal deformity on the spinal cord.  Eur Spine J.  1997;6:89–92 .→Chronic impairment bl. Supply local ischemia myelomalecia ( thining )atrophy of spinal cord Spinal kyphosis causes demyelination and neuronal loss in the spinal cord: a new model of kyphotic deformity using juvenile Japanese small game fowls K Shimizu, M Nakamura, Y Nishikawa, S Hijikata , K Chiba, Y Toyama Spine, 2005•journals.lww.com

44. Effect of LOCL on brain circulation  Substantial evidence suggests that the neurodegenerative process is initiated by chronic cerebral hypoperfusion (CCH) caused by ageing and C.V.conditions .  Di Marco LY, Venneri A, Farkas E, Evans PC, Marzo A, Frangi AF, et al. Vascular   Neurobiol Dis.  2015;82:593–606 The results of this case series show that correction of L O C L was associated with cerebral artery parameters indicating an immediate in blood flow in the brain Brain Circ.  2019 Jan-Mar; 5(1): 19–26.Published online 2019 Mar 27.  doi :  10.4103/bc.bc_25_18

45. Effect of LOCL on brain circulation in CBF indicated by cerebral arterial area and pixel intensity on brain MRA following correction of cervical lordosis This study follows another study which shows that hemodynamics in the cervical region is associated with loss of cervical curvature . Brain Circ.  2019 Jan-Mar; 5(1): 19–26. Published online 2019 Mar 27.  Evan A Katz ,  Seana B Katz ,  Curtis A Fedorchuk , 1   Douglas F Lightstone , 1   Chris J Banach , and  Jessica D Podoll 2

46. LOCL affecting brain circulation There was a direct relationship between loss of cervical curve ( lordosis ) and vertebral haemodynamics . loss of lordosis resulted in a diameter of the arteries, blood f low to the brain and peak systolic velocity when the curve in the neck is straightened out it blood flow into the brain and brainstem. If we bring the curve back to the neck, the blood flow returns July 5, 2019 How the curve of your neck impacts blood flow to the brain  

47. Effect of CK on different system On , spinal column- -- Spinal Instability compensatory sp. Curvature derangement ( straight back syndrome) Muscle ---------------- neck muscle overstrain-stiff, weak and atrophy develop Nerves………………… Radiculopathy Pressure/ traction on Cr. 9 th . 10 th & 11 th & Sympathetic chain sp. Cord – focal ischemic de- myelination ( Myelopathy ) Brain ----------------- impaired blood flow , venous stagnation &CSF stasis Vertebro - Basilar Insufficiency- - Tinnitus, vertigo ,drop attack Cervical Angina, Dystonia , Hiramaya disease Burning mouth syndrome, Stiffness ,Gait instability hiccough , Swallowing problem

48. Relation of 9 th , 10 th ,11 th .cr.n. to C 1 Jugular Foramen content 9th cr N + inferior petrosal vein 10 th . Cr N & 11 Cr.N Int. Jugular Vein.

49. 3D CT scan of upper cervical spine. C1-C2 instability can easily be seen in the patient, as 70% of C1 articular facet is subluxed posteriorly (arrow) on C2 facet when the patient rotates his head (turns head to the left then the right)

50. Patho -physiology of brain with cervical instability effect on arterial ,venous & CSF flow impairment

51. Uppercervical instability

52. How cervical spine instability pinches on arteries and disrupts, impedes, and retards blood flow into the brain.

53. Cervical soft tissue response to instability

54. Cervicocranial syndromes including Barré-Lieou Syndrome (caringmedical.com ) BARRÉ- LIÉOU SYNDROME A lesser known, yet relatively common, cause of neck pain is Barré-Liéou syndrome. In 1925, Jean Alexandre Barré , and in 1928, Yong Choen Liéou , symptoms were related to alterations in the posterior cervical sympathetic chain and vertebral artery blood flow in patients who had cervical spine arthritis or other arthritic disorders Barré-Liéou syndrome or posterior cervical sympathetic syndrome now presumed to develop more from disruption of the posterior cervical sympathetic nervous system, . Symptoms include neck pain, headaches, dizziness, vertigo, visual and auditory disturbances, memory and cognitive impairment, and migraines.

55. Bow hunter syndrome

56. Vision C. Sp. Instability can cause chronic neck pain. Blurring / double vision and osciliiopsia Heart C.Sp . Instability can cause heart palpitation B.P. & H.Rate problem Digestive System ANS affection in C.Sp . insta . can cause digestive disorder . Bladder& bawel Temporarily dysfunction due to vagus nerve affection Sweating   Excessive Sweating – Hyperhidrosis . Are often disappear with fixing upper cervical neck instability .

57. Effect of cervical instability people who have upper cervical spine instability, who come in for non-surgical treatments, have an amazing amount of brain fog, the inability to content rate, anxiety, and depression. on the point of depression, this is not a chemical depression that can be managed with antidepressants. This is a cervical spine structural depression causing altered blood flow to the brain causing an altered brain function.

58. Sagittal alignment of the cervical spine was measured by modified Cobb’s method ( mCM ) and posterior tangent method (PTM( Harrision ՚ s PTM Method )

59. Cervical curvature The cervical spine may feature some lordosis or kyphosis , or neutral, depending on the value of the C7 slope [ 11 ]. Patients with a C7 slope greater than 20° have a lordotic cervical spine.

60. Spino -cranial angle (SCA) The angle between the tangent to the upper C7 plateau and the line connecting the middle of the upper C7 plateau to the centre of the sella turcica . In asymptomatic persons, the SCA value is constant with a mean of 83° ± 9°. It is an important angle because it provides an idea of the head offset over C7–T1.Less than 74◦would affect the stability and posterior spinal extensor muscle including ligament nuchhie will be in constant strain.patint present with neck pain.

61. SVA of Cervical sp. C2-7 Sagittal Vertical Axis (SVA) is calculated by measuring the horizontal distance between the posterosuperior corner of the C7 vertebral body and a plumb line drawn from the centroid of C2. In general, C2-7 SVA < 4 centimeters is considered to be normal

62. Parameters for radiological diagnosi of LOCL

63. A Digital Motion X-Ray or DMX is used to understand a patient’s neck instability & helpful for the treatments. In the illustration of upper cervical instability demonstrated hypermobility of the C1-C2. This hypermobility can result in common symptoms of neck pain, headaches, dizziness, vertigo, tinnitus, concentration difficulties, anxiety, and other symptoms common in TMJ/TMD patients.

64. This image describes the impact of compression of the vagus nerve and the glossopharyngeal nerve on heart rate and blood pressure vagus nerve sensory fibers that regulate blood pressure are in the carotid artery glossopharyngeal nerve fibers are part of a network that carries impulses to the brain about heart rate and blood pressure moment to moment. If B.P. Through sympathetic action adrenalin B .P.& HR

65. Gastrointestinal symptoms and vagus nerve compression In this video Ross Hauser, MD. discusses a myriad of gastrointestinal symptoms that may be caused by vagus nerve compression typically found in cervical spine instability

66. TREATMENT PLAN FOR LOCL use of cervical collar no pillow bellow head during supine position Prophylactic can use rolled towel as bolster bellow the neck keep dex -top ,or mobile ,at horizontal gaze avoid un even weight bearing on shoulder Aim is to increase power of neck muscle correction of curvature of cervical sp. Physio -therapy Chriopractic Therapy prolo therapy Regenexx Procedures: Operative Decompression ----- Fusion ( To correct LOCL & Stabilization)

67. Non operative treatment of LOCL prolotherapy is the Hackett- Hemwall procedure which uses dextrose as the proliferant , there are multiple other choices that are suitable, such as polidocanol , manganese, human growth hormone, and zinc. prolotherapy is involve the treatment of joints, associated tendon and ligament attachments surrounding them; hence, it is a comprehensive and highly effective means of wound healing and pain resolution. The Hackett- Hemwall prolotherapy technique was developed in the 1950s and is being transitioned into mainstream medicine due to an increasing number of studies reporting positive outcomes [ 155 - 158 ].

68. New non operative treatment for LOCL Regenexx Procedures: A New Dawn in Treating Loss of Cervical Lordosis , is minimally invasive, reducing risks and recovery time .   Regenexx is a approach in the field of regenerative medicine. It involves using the body’s natural healing agents, such as  bone marrow concentrate (BMC)  and  platelet-rich plasma (PRP) to treat LOCL Regenexx procedures  utilize the body’s own/ auto repair mechanisms. It is by harvesting stem cells or platelets from the patient’s body, concentrating these cells, and then image guided re-injecting them into the affected area to promote healing and tissue regeneration. In the context of cervical lordosis , Regenexx procedures focus on reducing inflammation, promoting healing, and restoring the normal curvature of the spine

69. Hiramaya disease (2 nd -3 rd decade disease) with only distal motor affection U.L. Progression is stopped permanently following correction of cervical curve . distal atrophy in u. limb Normal & dynamic view of C.Sp . In hiramaya disease

70. Cervical instability and dystonia This patient is featured in the video below.  In this video, Dr. Ross Hauser reviews this article on 4 patients with dystonic storms who were found to have intermittent cerebral ischemia by Transcranial Doppler testing. These patients had improvement after a series of Prolotherapy to help stabilize their posterior cervical spine ligaments

71. J Phys Ther Sci. 2018 Jan; 30(1): 108–112. Published online 2018 Jan 27.  doi :  10.1589/jpts.30.108 Copyright/ License Request permission to reuse << Prev Fig . 2. Next >>

72. Thanking you

73. Cervical dystonia CERVICOGENIC HICOUGH CERVICAL DYSPHAGIA SWALLOWING DIFFICULTY FACE EAR THROAT PAIN TINITUS BURNING MOUTH SYNDROME MOOD DSORDE INTRACRANIAL HYPERTENSION CERVICAL ANGINA All of a sudden I had chest pain, chest heaviness, shortness of breath, and my heart was pounding.” history of migraines ,  sensitivity to sound ,  intermittent blurry vision , off-balance, as well as brain fog. DYSAUTONOMIA Postural Orthostatic Tachycardia Syndrome In my article  Postural Orthostatic Tachycardia Syndrome (POTS), the Vagus Nerve and Cervical S pine instability Strange sensations in the skin . Symptoms including tactile allodynia or painful to the touch skin, skin sensations where one-half of their body will feel hot and one-half of their body will feel cold, rashes, and problems of S weating Thermoregulatory instability and a patient’s inability to temperature regulate . Hot and cold, sweaty hands

74. Hypertension, anxiety, dizziness,  blurry vision, neck pain, heart in c.sp . instability Vision The SNS controls pupil dilation to help to see better by allowing in more light to eye to help fight or flight. The PNS restores proper pupil function when the stress passes. A malfunctioning ANS can lead to vision problems and pupil dilation. C Sp. instability causes Chronic Neck Pain and Blurred or Double Vision  and  Oscillopsia Heart The SNS controls heart rate. Forcing blood through body to make sure one to have enough oxygen. The PNS system slows down the heart rate and lowers the blood pressure when the stress passes. A malfunctioning Autonomic nervous system can lead to “cardiac” symptoms. Please see our articles:  Can cervical spine instability cause heart palpitations and blood pressure problems?  and  Heart Rate Variability . Digestive system The SNS controls energy flow to the G.I..systems during times of flight/fight. It slows down digestion so the legs and arms can get the blood they need as a priority. The P.N.S.restarts the digestive system when stress passes. A malfunctioning ANS can lead to many digestive problems symptoms. The C Spi. instability presents as a cause of digestive disorders . Temporarily stopping the need to urinate The S.N.S.activates and/or stops your need to urinate during a fight/flight situation. The parasympathetic nervous system restarts the bladder/kidney function. A malfunctioning A N S → urinary problems Vagus nerve compression, as cause urinary incontinence Sweating to keep cool The S.N.S. controls body temperature during a fight/flight situation. It tries to keep you cool to avoid overheat. The parasympathetic nervous system restarts the proper sweating/cooling systems when the stress passes. A malfunctioning Autonomic nervous system can lead to sweating problems. Please see our article:  Excessive Sweating – Hyperhidrosis . Are fixing upper cervical neck instability problems the missing treatment?