by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
Chiropractic Journal of Australia : CJA March 2013
Chiropractic Journal of Australia Volume 43 Number 1 March 2013 29 INTRODUCTION The atlas (C1) is the most superior cervical vertebrae and is formed from three ossifcation centers. Two lateral centers extend posterolateraly and fuse together by 3 to 5 years of age, forming the posterior arch.1 Chung2 estimated that congenital bony anomalies of the atlas are present in 0.3% to 0.7% of the population, although other studies have indicated a much higher incidence of between 4% and 6%.3-8 Cleft of anterior arch of the atlas is extremely rare and is present in 0.1% of the population.9 A failure to fuse of the posterior arch of the atlas is known as spina bifda occulta (SBO), and according to research by Childers and Wilson occurs in approximately 1% to 6% of population.3 The most in depth research into the incidence of congenital non-union of the posterior vertebral arch of C1 was performed on 1613 postmortem specimens and found a 4% incidence of SBO in the general population.4-8 Clinical signifcance of spina bifda occulta of the atlas remains controversial. Currarino described fve potential clinical presentations of SBO of the atlas: The Clinical Signifcance of Spina Bifda Occulta at C1: A Case Control Study MICHAEL R GLOVER, RAFAL KWASNIEWSKI, PETER BULL and HAZEL JENKINS Michael R Glover, BSc, MChiopr Macquarie University Sydney, Australia Rafal Kwasniewski, BSc, MChiropr Macquarie University Peter Bull, DC, MAppSc, Honourary Associate Department of Chiropractic Macquarie University Hazel Jenkins, BMedSci, MChiropr, MAppSci Lecturer in Radiology, Department of Chiropractic Macquarie University Received 21 February, accepted 3 March 2013 No confict of interest was noted Abstract: Aim: The purpose of the paper was to investigate any correlation between spina bifda occulta of the atlas (SBO of C1) and the incidence of headaches or neck pain in a cohort of patients presenting for chiropractic treatment. Methods: A case control study design was selected for this research. Patients were selected retrospectively from those that had presented for chiropractic treatment at the Macquarie University chiropractic outpatient clinics. The presence of self-reported headache (HA) and neck pain (NP) at the time of initial consultation was compared in two groups of 32 subjects. All patients in the experimental group had SBO of C1 evident on x-ray; the control group was formed from gender matched patients whose x-rays did not show SBO of the atlas. Results: 50% of the experimental group reported neck pain or headache on initial consult compared to 46.9% in the control group. Statistical analysis indicated no signifcant difference in the frequency of headache or neck pain reported between the two groups.Conclusion: These results indicate that SBO of C1 does not appear to be associated with an increased presentation of headache or neck pain. INDEX TERMS (MeSH): SPINA BIFIDA OCCULTA; ATLAS; NECK PAIN; HEADACHE. (OTHER) C1; SPONDYLOSCHISIS. Chiropr J Aust 2013;43:29-32. 1. Asymptomatic, with detection occurring incidentally during radiographic imaging. 2. Neck pain related to trauma. 3. The development of sudden neurological symptoms. 4. A variety of neurological symptoms for some time before discovering abnormality. 5. SBO discovered during chronic neck pain workup.10 Conversely other authors have concluded that SBO of C1 is of little clinical signifcance and is most often an incidental fnding.6,11-13 The aim of our study is to investigate whether SBO of the atlas is associated with an increased presentation of headache (HA) and neck pain (NP) and therefore whether SBO of C1 may be a contributing factor within these pain syndromes. METHODS I. Literature search A search through the scientific databases: Index to Chiropractic Literature, Science Direct and Ovid-Medline was performed. The key words used were: (spina bifda) OR (posterior arch defect) OR (posterior arch cleft) AND (atlas) OR (C1) OR (spondyloschisis) OR (correlation) OR (association). The search for papers on a correlation between SBO of C1 and HA or NP returned very few hits, with the majority of publications being case reports of less than 10 patients. II. Participants The study was conducted on patients who presented for chiropractic treatment to one of the three Macquarie University Chiropractic outpatient clinics. Screening of
CJA December 2012
CJA June 2013