Atlanto-axial Subluxation: Treatable Cause of Post Concussion Syndrome (P5.305)

Abstract

Objectives: To investigate regional cervical pain and instability as a cause of chronic post concussion symptoms and the efficacy of interventions to mitigate them. Background: The etiology of post concussion syndrome has not been studied systematically Methods: We performed an IRB approved retrospective review of a clinical records from patients with post-concussion symptoms of headache, afferent hypersensitivity, dizziness, sleep disturbance, fatigue, irritability, forgetfulness, mental slowing and decreased concentration, from a comprehensive concussion clinic, direct measurements of atlanto-axial subluxation on plain x-rays as well as assess the efficacy of treatments by correlation analysis of pain and depression symptoms as well as measured subluxation. Results: 194 subjects were divided into two groups: stable (112 pts <1mm subluxation) vs unstable (82 pts 蠅1 mm subluxation) for comparison. Comparative analysis of symptoms and subluxation were performed over time to asses for treatment effects. Mean C1-C2 subluxation 3.27 mm on dynamic cervical spine x-rays, mean age 22 y, mean duration till treatment 173 days, 68 % female, with 96 patients having concurrent occipital neuritis with trigger point exacerbation of headaches, requiring mean 2.36 nerve blocks with steroid injections for relief. Cervical soft collar 6-9 weeks for subluxation had reduction to mean 0.57 mm subluxation (p<0.0001). Both groups had significant reduction in symptoms by week 4 on the Cicerone mild TBI symptoms scales when treated with focused therapy. We also showed a significant reduction in PHQ-9 depression scores by week 4 in conjunction with reduction in overall symptom scores. Conclusion: Clinically focused exam and therapies for patients with post concussion symptoms secondary to cervical ligament laxity and post traumatic occipital neuritis showed a significant treatment effect with accelerated reduction of chronic, debilitating symptoms when compared to rest and unfocused therapies.

Disclosure: Dr. Crutchfield has nothing to disclose. Dr. Rivenburgh has nothing to disclose. Dr. Morris has nothing to disclose. Dr. Werner has nothing to disclose.