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Upper cervical instability: fact or fiction?

R A Swinkels1, R A Oostendorp

  • 1Faculty of Medicine and Pharmacy, Brussels Free University, Belgium.

Journal of Manipulative and Physiological Therapeutics
|March 1, 1996
PubMed
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Clinical stability tests for the upper cervical spine lack correlation with symptoms, and radiology is not a reliable diagnostic tool for atlanto-axial instability. Further research is needed to validate these diagnostic methods.

Area of Science:

  • Orthopedics and Sports Medicine
  • Diagnostic Imaging
  • Physical Therapy

Background:

  • Atlanto-axial hypermobility and instability are complex conditions affecting the upper cervical spine.
  • Clinical symptomatology associated with upper cervical spine instability can be varied and nonspecific.
  • The diagnostic utility of clinical tests and radiological imaging for upper cervical spine instability remains a subject of debate.

Purpose of the Study:

  • To critically evaluate the internal validity of standardized clinical stability tests for the upper cervical spine.
  • To assess the reliability of radiological methods in confirming clinical diagnoses of upper cervical spine instability.
  • To discuss the role of radiology, pathogenesis, prevalence, and clinical presentation of atlanto-axial hypermobility.

Main Methods:

Related Experiment Videos

  • Comprehensive literature search from 1984 to 1995 using keywords related to atlanto-axial instability and cervical spine.
  • Inclusion of 96 publications in Dutch, French, German, and English.
  • Consultation of specialized documentation centers and inclusion of recent developments.

Main Results:

  • No significant correlation was found between the degree of hypermobility or subluxation and the presence of clinical or neurological signs.
  • Clinical presentations ranged from diffuse complaints to serious neurological deficits.
  • Conventional X-rays were found to be inadequate for assessing atlanto-axial stability; CT and MRI offer better visualization but are not definitive standards.

Conclusions:

  • The validity of upper cervical spine stability tests is questionable due to the lack of correlation with clinical symptoms.
  • Radiological examinations primarily measure anatomical variables, not functional ones, limiting their diagnostic value for instability.
  • Despite limitations, CT and MRI are recommended over conventional functional radiology for diagnosing upper cervical spine conditions.