[Atlas block and alar ligament lesion-Underestimated or overrated?]

IF 1.1 4区 医学 Q3 ANESTHESIOLOGY Schmerz Pub Date : 2024-10-01 Epub Date: 2023-07-19 DOI:10.1007/s00482-023-00731-8
J Wölfle-Roos
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Abstract

Background: Disorders of the upper cervical spine, most notably lesions of the alar ligament and atlas block, are associated with numerous symptoms, especially as reported in the lay press. Thus, physicians are often confronted with patients who see in them a monocausal origin of complex complaints and hope for a quick remedy.

Objective: This review article presents the currently available evidence-based literature on atlas block and alar ligament lesions in order to adequately appreciate their significance.

Material and methods: Summary and critical evaluation of an extensive review of the literature on the diagnostics, clinical presentation, and treatment of disorders of the upper cervical spine.

Results: The current literature shows that alar ligament lesions are caused only by extremely high-speed trauma and that the reliability of their detection on magnetic resonance imaging (MRI) is moderate at best. As several studies have failed to demonstrate a correlation between symptoms and abnormalities of the alar ligaments on MRI, surgical stabilization of the upper cervical joints is not indicated. The diversity of symptoms associated with atlas block may be explained by the convergence of afferent neurons originating in C1-C3 on several cranial nerve nuclei found in neuroanatomical studies, but this association has yet to be proven. First studies show that highly significant improvements in cervical pain and range of motion can be achieved by means of manual therapy of the upper cervical spine with lasting effects even after 6 months.

Conclusion: The importance of alar ligament lesions has often been overrated in the past; however, a more nuanced multifactorial understanding of the disorder should be conveyed to the patient. An atlas block should be considered mainly as a possible cause of pain and restricted range of motion of the cervical spine and in this context manual therapy can be an effective treatment option.

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[地图集阻滞和耳廓韧带病变--低估还是高估?]
背景:上颈椎的疾病,特别是椎韧带和寰椎阻滞的病变,与众多症状相关,尤其是在非专业媒体的报道中。因此,医生经常会遇到这样的病人,他们认为复杂的主诉是由单一病因引起的,并希望得到快速的治疗:这篇综述文章介绍了目前关于寰椎阻滞和耳廓韧带病变的循证文献,以充分认识其重要性:对有关上颈椎疾病的诊断、临床表现和治疗的大量文献进行总结和批判性评估:现有文献表明,耳廓韧带病变仅由极高速创伤引起,磁共振成像(MRI)对其检测的可靠性充其量为中等。由于多项研究未能证明症状与磁共振成像上的椎间韧带异常之间存在相关性,因此不建议通过手术来稳定上颈椎关节。神经解剖学研究发现,源自 C1-C3 的传入神经元汇聚于多个颅神经核,这可能解释了寰椎阻滞相关症状的多样性,但这种关联性尚待证实。首次研究表明,通过对上颈椎进行手法治疗,颈椎疼痛和活动范围可以得到非常明显的改善,甚至在 6 个月后仍有持续效果:结论:过去,人们常常高估椎弓根韧带病变的重要性;然而,应向患者传达对这一疾病更细致入微的多因素认识。寰椎阻滞主要应被视为导致颈椎疼痛和活动范围受限的可能原因,在这种情况下,手法治疗不失为一种有效的治疗方法。
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来源期刊
Schmerz
Schmerz 医学-临床神经学
CiteScore
2.00
自引率
20.00%
发文量
64
审稿时长
6-12 weeks
期刊介绍: Der Schmerz is an internationally recognized journal and addresses all scientists, practitioners and psychologists, dealing with the treatment of pain patients or working in pain research. The aim of the journal is to enhance the treatment of pain patients in the long run. Review articles provide an overview on selected topics and offer the reader a summary of current findings from all fields of pain research, pain management and pain symptom management. Freely submitted original papers allow the presentation of important clinical studies and serve the scientific exchange. Case reports feature interesting cases and aim at optimizing diagnostic and therapeutic strategies. Review articles under the rubric ''Continuing Medical Education'' present verified results of scientific research and their integration into daily practice.
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