Lluis Manent¹ and Orlando Angulo²*

¹Continuing Medical Education, Fundacion Universitaria de Ciencias de la Salud. Bogotá, Colombia
²Department of Medicine, Univerisidad Cooperativa de Colombia, Sede Villavicencio, Villavicencio, Colombia

*Corresponding Author: Orlando Angulo Ceballos, Department of Medicine, Cooperative University of Colombia, Campus Villavicencio, Villavicencio, Colombia.

Received: April 26, 2024; Published: June 19, 2024

Abstract

Background: Herniated lumbar discs can impair gait. The Atlasprofilax method is a device-mediated and non-invasive intervention that uses vibropercussive mechanotransduction on the suboccipital myofascia. Addressing cervical myofascial abnormalities may benefit descending myofascial chains, relieving the spine, discs, joints, and nerves from overloads and asymmetrical forces, improving motor function and reducing nociception response.

Case report: A 66-year-old patient presented with total gait impairment presumably associated to three lumbar herniated discs. The patient remained wheelchair-bound for four months despite undergoing daily physiotherapy rehabilitation. Symptoms included right brachialgia, severe low back and lower limb pain, and bilateral sciatica associated with the three herniated lumbar discs. The patient experienced a complete inability to stand and walk, necessitating confinement to a wheelchair for the past four months. Three hours following the intervention, the patient exhibited gradual improvement in walking ability, achieving complete gait control within one week. Marked improvement was observed in sciatica and low back pain. Over a follow-up period of 29 months, sustained pain relief and full recovery of gait were observed.

Conclusions: We propose that alterations of the cervical musculature and deep fascia could predispose to the development of lumbar disc abnormalities. We suggest that the observed improvements in this patient may be attributed to the reduction of asymmetric force distribution and elastic loading within the myofascial chains, leading to intervertebral decompression and radicular release. Furthermore, the mechanotransductive effect of the intervention on the suboccipital myofascia may have positively influenced specific brainstem-related myodural connections, subsequently impacting spinal cord function and gait processing as a result of the Atlasprofilax treatment.

Keywords: Gait; Cervical Atlas; Herniated Disc; Sciatica

References

1. Tacu C., et al. “Gait temporospatial parameters : assessment tools for post- surgical recovery in patient with different anatomo- topographic types of lumbar disc herniation (2010): 339-347.
2. Natarajan P., et al. “Analysing Gait Patterns in Degenerative Lumbar Spine Disease Using Inertial Wearable Sensors: An Observational Study”. World Neurosurgery 163 (2022): e501-515.
3. Lee K., et al. “Association between pain and gait instability in patients with lumbar disc herniation”. Journal of International Medical Research 8 (2021): 28-34.
4. Takada E., et al. “Natural history of lumbar disc hernia with radicular leg pain: Spontaneous MRI changes of the herniated mass and correlation with clinical outcome”. Journal of Orthopaedic Surgery 1 (2001): 1-7.
5. Zheng C., et al. “Correlations of Japanese Orthopaedic Association Scoring Systems with Gait Parameters in Patients with Degenerative Spinal Diseases”. Orthopedic Surgery 4 (2016): 447-453.
6. Takakusaki K. “Functional Neuroanatomy for Posture and Gait Control”. Journal of Movement Disorders 1 (2017): 1-17.
7. Koh M and Markovich B. “Neuroanatomy, Spinocerebellar Dorsal Tract”. StatPearls (2020).
8. Alonso C., et al. “Muscle trigger point therapy in tension-type headache”. Expert Review of Neurotherapeutics3 (2012): 315-322.
9. Fernández-De-Las-Peñas C., et al. “Magnetic resonance imaging study of the morphometry of cervical extensor muscles in chronic tension-type headache”. Cephalalgia 4 (2007): 355-362.
10. Fernández-De-Las-Peñas C., et al. “Association of cross-sectional area of the rectus capitis posterior minor muscle with active trigger points in chronic tension-type headache: A pilot study”. American Journal of Physical Medicine and Rehabilitation3 (2008): 197-203.
11. Rosa S., et al. “Craniocervical Junction Syndrome: Anatomy of the Craniocervical and Atlantoaxial Junctions and the Effect of Misalignment on Cerebrospinal Fluid Flow”. Hydroceph - Water Brain (2018).
12. Jiang W., et al. “Effectiveness of physical therapy on the suboccipital area of patients with tension-type headache: A meta-analysis of randomized controlled trials”. Medical (United States)19 (2019): e15487.
13. Espi López G and Oliva Pascual Vaca A. “Atlanto-Occipital Joint Manipulation and Suboccipital Inhibition. Tecnique in the Osteopathic Treatment of Patients with Tension-Type Headache”. European Journal Osteopathy and Related Clinical Research1 (2012): 10-21.
14. Gemma V EL and Antonia GC. “Efficacy of Manual and Manipulative Therapy in the Perception of Pain and Cervical Motion in Patients With Tension-Type Headache: A Randomized, Controlled Clinical Trial”. Journal of Chiropractic Medicine 1 (2014): 4-13.
15. Espí-López GV., et al. “Treatment of tension-type headache with articulatory and suboccipital soft tissue therapy: A double-blind, randomized, placebo-controlled clinical trial”. Journal of Bodywork and Movement Therapies 4 (2014):576-585.
16. Yuan XY., et al. “Correlation between chronic headaches and the rectus capitis posterior minor muscle: A comparative analysis of cross-sectional trail”. Cephalalgia 11 (2017): 1051-1056.
17. Alix ME and Bates DK. “A proposed etiology of cervicogenic headache: The neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle”. Journal of Manipulative and Physiological Therapeutics 8 (1999): 534-539.
18. Fernández-de-las-Peñas C., et al. “Myofascial trigger points in the suboccipital muscles in episodic tension-type headache”. Manual Therapy 3 (2006): 225-230.
19. Li YX., et al. “Effectiveness and Safety of Acupuncture for Migraine: An Overview of Systematic Reviews”. Pain Research and Management (2020).
20. MY S., et al. “Utilization of MR imaging in myodural bridge complex with relevant muscles: current status and future perspectives”. Journal of Musculoskeletal and Neuronal Interactions 3 (2020): 382-389.
21. Scali F., et al. “The Posterior Atlantooccipital Membrane: The Anchor for the Myodural Bridge and Meningovertebral Structures”. Cureus (2022).
22. Gonzales J and Iwanaga J. “Comprehensive Review of the Posterior Atlanto-Occipital Membrane”. Spine Schedule 1 (2018): 6-8.
23. Scali F., et al. “Proprioceptive neurons in the cervical myodural bridge : a feedback mechanism of dural tension monitoring” (2013).
24. Scali F., et al. “Investigation of meningomyovertebral structures within the upper cervical epidural space: A sheet plastination study with clinical implications”. Spine Journal 11 (2015): 2417-2424.
25. Nash L., et al. “Configuration of the connective tissue in the posterior atlanto-occipital interspace: A sheet plastination and confocal microscopy study”. Spine (Phila Pa 1976) 12 (2005): 1359-1366.
26. Kahkeshani K and Ward PJ. “Connection between the spinal dura mater and suboccipital musculature: Evidence for the myodural bridge and a route for its dissection-A review”. Clinical Anatomy 4 (2012): 415-422.
27. Scali F., et al. “Histological analysis of the rectus capitis posterior major’s myodural bridge”. Spine Journal5 (2013): 558-5563.
28. Palomeque-Del-cerro L., et al. “A Systematic Review of the Soft-Tissue Connections Between Neck Muscles and Dura Mater”. Spine (Phila Pa 1976) 1 (1992): 49-54.
29. Hallgren RC., et al. “Clinical implications of a cervical myodural bridge” (1997).
30. Enix DE., et al. “The cervical myodural bridge, a review of literature and clinical implications”. The Journal of the Canadian Chiropractic Association 2 (2014): 184-192.
31. Pontell ME., et al. “Histological examination of the human obliquus capitis inferior myodural bridge”. Annals of Anatomy 6 (2013): 522-526.
32. Song X., et al. “The relationship between compensatory hyperplasia of the myodural bridge complex and reduced compliance of the various structures within the cranio-cervical junction”. The Anatomical Record (2022).
33. Zheng N., et al. “Definition of the to be named ligament and vertebrodural ligament and their possible effects on the circulation of CSF”. PLoS One 8 (2014).
34. Li C., et al. “The relationship between myodural bridges, hyperplasia of the suboccipital musculature, and intracranial pressure”. PLoS One (2022): 17.
35. Labuda R., et al. “A new hypothesis for the pathophysiology of symptomatic adult Chiari malformation Type I”. Medical Hypotheses (2022): 158.
36. Palamar D., et al. “Posturographic examination of body balance in patients with Chiari type I malformation and correlation with the presence of syringomyelia and degree of cerebellar ectopia”. Turkish Journal of Physical Medicine and Rehabilitation 1 (2019): 74-79.
37. León JG., et al. “Total Resorption of a Chronic L4-L5 Disc Extrusion After Application of the Atlasprofilax Method: A Case Report”. American Journal of Case Reports (2022): 23.
38. Malagón J., et al. “A Therapeutic Alternative in the Management of Fibromyalgia”. Revista cuarzo 1 (2017): 30.
39. Manent L., et al. “Impact of the Atlasprofilax Method on Body Balance on High Performance Archery Olympic Athletes: A Case Series”. American Journal of Case Reports (2023): 24.
40. Orlando Angulo and Lluis Manent. “Impact of the Atlasprofilax Method on a Patient with Degenerative Spine Disease and Chronic Myofascial Pain Syndrome: A Case Report”. Acta Scientific Orthopaedics 8 (2023): 133-40.
41. Orlando Angulo., et al. “Radiological Improvements in Symmetry of the Lateral Atlantodental Interval and in Atlas Tilt after the Application of the Atlasprofilax Method. A Case Series”. CPQ Orthopaedics 3 (2022): 1-13.
42. G León J., et al. “Clinical and Imaging Improvement After the Atlasprofilax Method in a Patient with Cervicobrachial Syndrome and Temporomandibular Joint Disorders. A Case Report”. Acta Scientific Orthopaedics 10 (2021): 92-102.
43. Gutiérrez Navas VE. “EFECTO DE LA TERAPIA AtlasPROFILAX® SOBRE LOS SÍNTOMAS RELACIONADOS CON DISFUNCIÓN TEMPOROMANDIBULAR, BRUXISMO Y LA RELACIÓN DE LAS LÍNEAS MEDIAS DENTALES”. UstaSalud2 (2013):124.
44. Bracco P., et al. “Effects of different jaw relations on postural stability in human subjects”. Neuroscience Letters 3 (2004): 228-230.
45. KD J., et al. “Postural control deficits in people with fibromyalgia: A pilot study”. Arthritis Research and Therapy4 (2011).
46. Larsen K. “Atlas joint instability: Causes, consequences and solutions”. Train Rehabilitation (2017).
47. Angulo O. “The Mystery around Suboccipital Myofascial Alterations and their Correlated Ailments. Could the Atlasprofilax Method be a Therapeutic Option?” EC Orthopaedics 3 (2023): 1-5.
48. Mahmoud WSE. “Effect of Neural Mobilization Versus Spinal Manipulation in Patients with Radicular Chronic Low Back Pain”. European Journal of Scientific Research 1 (2015): 122-32.
49. Suzuki H., et al. “Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain”. PLoS One3 (2020).
50. , et al. “Outcomes of acute and chronic patients with magnetic resonance imaging-confirmed symptomatic lumbar disc herniations receiving high-velocity, low-amplitude, spinal manipulative therapy: A prospective observational cohort study with one-year follow-up”. Journal of Manipulative and Physiological Therapeutics 37.3 (2014): 155-163.
51. CK P., et al. “Are Modic changes related to outcomes in lumbar disc herniation patients treated with imaging-guided lumbar nerve root blocks?” European Journal of Radiology 10 (2014): 1786-1792.
52. Thompson PD and Kimber TE. “Brainstem lesions and gait”. Handbook of Clinical Neurology 159 (2018): 359-66.
53. Gürer B., et al. “Microsurgical anatomy of the denticulate ligaments and their relationship with the axilla of the spinal nerve roots”. Clinical Anatomy 5 (2014): 733-737.
54. Mackinnon Colum D. “Sensorimotor anatomy of gait, balance, and falls”. Handbook of Clinical Neurology 159 (2018): 3-26.
55. Tubbs RS., et al. “The intracranial denticulate ligament: Anatomical study with neurosurgical significance: Laboratory investigation”. Journal of Neurosurgery 2 (2011): 454-457.

Citation

Citation: Lluis Manent and Orlando Angulo. “Rapid Recovery of a Patient Constrained in a Wheelchair with Total Gait Impairment Associated to Three Lumbar Herniated Discs After the Application of a Non-invasive Mechanotransductive Vibropercussive Intervention on the Suboccipital Myofascial (Atlasprofilax Method)".Acta Scientific Orthopaedics 7.7 (2024): 46-54.

Copyright

Copyright: © 2024 Lluis Manent and Orlando Angulo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.