Manual fixation versus locking during upper cervical segmental mobilization. Part 2: an in vitro three-dimensional arthrokinematic analysis of manual axial rotation and lateral bending mobilization of the atlanto-axial joint

BackgroundThree-dimensional kinematic aspects of coupled motion during manual cervical mobilization have not previously been studied. Using an in vitro 3D-motion analysis method, the kinematic effects of two different segmental techniques for axial rotation and lateral bending mobilization of the upper cervical spine were investigated as a second part of the study (in part one, kinematic effects of flexion-extension mobilization have been investigated).MethodsAxial rotation and lateral bending mobilization of the atlanto-occipital and atlanto-axial segments were analysed in vitro using an electromagnetic tracking device. Local reference frames were defined based on bony reference points that were registered using a 3D-digitizing stylus.Five embalmed and one fresh specimen were analysed. Segmental motion was registered simultaneously in the atlanto-occipital and the atlanto-axial joints during manual mobilization through the full range of axial rotation and lateral bending mobility. The 3D-kinematic aspects during regional mobilization were compared with those during segmental mobilization with manual fixation and during segmental mobilization using a locking technique.ResultsDuring both segmental axial rotation techniques of the atlanto-axial joint, a significant reduction of the coupled lateral bending and flexion-extension motion was observed. The locking technique also induced an increase in the main axial rotation component. During lateral bending mobilization of the atlanto-axial joint, the manual fixation technique reduced the effect on the coupled flexion-extension component significantly.InterpretationsThese results suggest that for manual segmental axial rotation and lateral bending mobilization of the upper cervical spine segmental manual fixation or locking may be preferred in different situations depending on the desired effects. This study brings additional information to the data provided by part 1 of this study on the 3D-arthrokinematic effects of flexion-extension mobilization.     

Spinal connections of ventral-group bulbospinal inspiratory neurons studied with cross-correlation in the decerebrate rat

We examined the synaptic connections from ventral-group bulbospinal inspiratory neurons to upper cervical inspiratory neurons and phrenic and intercostal motoneurons in decerebrate rats using cross-correlation. Inspiratory neurons were recorded in the medulla (n=28) at the level of the obex and from the upper-cervical segments (C1 and C2) of the spinal cord (n=29) in 18 vagotomized, paralyzed, ventilated, and decerebrated rats. The neurons were identified by their inspiratory firing pattern and antidromic activation from the spinal cord at C7. Whole-nerve recordings were made using bipolar electrodes from the central cut ends of the C5 phrenic nerve and the external and internal intercostal nerves at various thoracic levels. Cross-correlation histograms were computed between these recordings to detect short time scale synchronizations indicative of synaptic connections. Cross-correlation histograms (n=20), computed between the activities of ventral-group bulbospinal inspiratory neurons and the phrenic nerve, all showed peaks (mean half-amplitude width±SD, 1.1±0.3 ms) at short latencies (mean latency±SD, 2.0±0.6 ms) suggestive of monosynaptic excitation. Cross-correlation histograms (n=33), computed between the activities of ventral-group bulbospinal inspiratory neurons and upper-cervical inspiratory neurons, displayed four (12%) peaks (mean halfamplitude width±SD, 0.9±0.1 ms) at short latencies(mean latency±SD, 1.8±0.6 ms) suggestive of monosynaptic excitation, and six (18%) peaks (mean half-amplitude width±SD, 1.4±0.4 ms) at latencies near zero suggestive of excitation fro m a common source. Cross-correlation histograms (n=34), computed between the activities of ventral-group bulbospinal inspiratory neurons and the internal and external intercostal nerves at various thoracic levels (T2-8), showed six (18%) peaks (mean half-amplitude width±SD, 2.5±0.5 ms) at short latency (mean latency±SD, 4.5±1.1 ms) suggestive of oligosynaptic connections. Cross-correlation histograms (n=42) computed between activities of intercostal nerves at various levels of the thoracic spinal cord showed central peaks suggestive of excitation from a common source. Although the size of the peaks decreased with segmental separation, the displacement of the peaks from time zero did not increase with segmental separation (mean displacement±SD, 0.6±0.6 ms) as would be expected if the common excitation resulted from a descending monosynaptic excitation by a source such as the ventral-groupbulbospinal inspiratory neurons. We conclude that all ventral-group bulbospinal inspiratory neurons make monosynaptic connections to phrenic motoneurons, a few make monosynaptic connections to upper-cervical inspiratory neurons, but connections to intercostal motoneurons are made via interneurons.     

Segmental reflex inputs to motoneurons innervating dorsal neck musculature in the cat

Summary The responses to Stimulation of upper cervical muscle and cutaneous afferents were studied in motoneurons innervating splenius, complexus, and biventer cervicis dorsal neck muscles of cats. Motoneurons innervating complexus and biventer cervicis fibers, which are in the deeper, longitudinally oriented muscles, were monosynaptically excited by ipsilateral Group I afferents from each of these muscles, but they did not receive significant input from splenius Group I afferents. Likewise, splenius motoneurons were not monosynaptically excited by ipsilateral afferents from complexus and biventer cervicis. Stimulation of ipsilateral cutaneous afferents produced predominant excitation in splenius motoneurons, predominant inhibition in biventer cervicis motoneurons, and inhibition or mixed responses in complexus motoneurons.None of the neck motoneurons studied showed postsynaptic potentials following single or multiple shock stimulation of contralateral muscle nerves at stimulus intensities expected to excite exclusively Group I afferents. Higher intensity stimulation of contralateral muscle afferents, as well as fibers in the greater auricular nerves, produced predominant inhibition in all three neck motoneuron pools.Segmentally-excited afferents to neck motoneurons, like those from supraspinal systems, appear to evoke different patterns of synaptic responses in splenius motoneurons than they do in motoneurons innervating fibers in the deeper, longitudinally oriented complexus and biventer cervicis muscles.