Upper Cervical Instability
Upper Cervical Instability of Traumatic Origin Treated with Dextrose Prolotherapy: A Case Report
Hauser R, Steilen-Matias D, Fisher P. Upper cervical instability of traumatic origin treated with dextrose prolotherapy: a case report. Journal of Prolotherapy. 2015;7:e932-e935.
Introduction: Ligamentous injury is widely viewed as a key to the pathophysiology of chronic neck pain. However, this hypothesis has little support with respect to data correlating patient status with either repair-promoting treatments or documentation of regained stability. Dextrose prolotherapy can potentially promote inflammatory and repair processes in these tissues. We describe a case employing this approach, coupled with longitudinal stability assessment, in a patient with chronic neck pain associated with atlantoaxial lesions.
Case presentation: A 47-year-old female with a history of trauma presented to our clinic in 2013 with headaches, chronic pain in the neck and upper limbs, and intermittent tingling in one arm. Pain was exacerbated by head movement. Examination showed crepitation at C0 – C2, and severe spasms and tenderness in the trapezius and paraspinal muscles. The patient was treated with dextrose prolotherapy at each of four visits over five months. Digital motion X-ray (DMX) was performed between visits 1 and 2, showing straightening of cervical lordosis and upper and lower cervical instability, with offsets of right and left lateral masses of C1 on C2, anterolisthesis of C2 on C3 and of C3 on C4, capsular ligament damage at C6-C7 and facet hypertrophy at C4-C5. At visit 2, tingling and crepitation had abated, while pain intensity was unchanged. At visit 3, headaches had resolved, and pain had become more localized. At visit 4, pain intensity had decreased significantly, crepitation had resolved completely, and she had begun bicycle exercise. DMX one month after visit 4 showed persistent straightening of lordosis and facet hypertrophy, as well as some anterolisthesis, while the offsets of the lateral masses of C1 on C2 with rotation were reduced by 33-50%.
Conclusions: Dextrose prolotherapy was associated with progressive symptomatic relief and functional gain, beginning one month after initiation of treatment, and also with improvement of upper cervical stability. The findings support an approach to chronic neck pain based on the facilitation of ligamentous repair.