Ultrasound criteria for biomechanical component of local and regional level somatic dysfunction in case of myogenic torticollis

Introduction. Myogenic torticollis is the most common injury in children′s musculoskeletal system. Atlantoaxial rotatory subluxation is one of the main reasons for this pathology. In the newborn even a minor injury during pathological delivery can cause this. The ultrasound method allows you to conduct a real time examination and provide the physician by complete information about the state of pulpal nucleus, fi brous ring, and relative position of cervical vertebrae bodies, spinal canal and radicular canals. Also it allows you to estimate neck muscles thickness and area, which is an informative complementary method of osteopathic diagnosis.

Goal of research — clarifi cation of the criteria for biomechanical component of local and regional level somatic dysfunction by ultrasound examination of the cervical spine Materials and methods. The paper presents the data of cervical spine ultrasound examination for 57 nursing infants, infants and preschoolers with myogenic torticollis due to birth injury (ICD code X: P 15.8).

Results. An ultrasound examination of the cervical spine determined the quantitative parameters of the atlantoaxial joint and the spinal canal, which was 17,57±0,44 mm. By posterior approach, the asymmetric position of the C II odontoid bone with respect to lateral masses of the atlas was determined; a statistically signifi cant width difference in atlantoaxial joint space was revealed (p<0,001). By muscles ultrasound examination, signifi cant thickness differences between left and right larger posterior straight muscles of the head (p<0,05) were found. Signs of instability at the CII–CIII level were detected in all patients, with no instability signs at other levels.

Conclusion. The established criteria for ultrasound examination are atlantoaxial joint state, hypermobility of spinal motor segments, as well as muscles thickness and area in region under study. This allows us to verify instrumentally biomechanical SD of both local and regional levels, thus dynamic control over osteopathic treatment effectiveness is possible.

1. Bredenkamp J. K., Hoover L. A., Berke G. S., Shaw A. Congenital muscular torticollis. A spectrum of disease. Arch. Otolaryngol. Head Neck. Surg. 1990 Feb; 116 (2): 212–216.

2. Do T. T. Congenital muscular torticollis: current concepts and review of treatment. Curr. Opin. Pediat. 2006 Feb; 18 (1): 26–29. https://doi.org/10.1097/01.mop.0000192520.48411.fa.

3. Kinon M. D., Nasser R., Nakhla J., Desai R., Moreno J. R., Yassari R., Bagley C. A. Atlantoaxial Rotatory Subluxation: A Review for the Pediatric Emergency Physician. Pediat. Emerg. Care. 2016 Oct; 32 (10): 710–716. https://doi.org/10.1097/PEC.0000000000000817.

4. Neal K. M., Mohamed A. S. Atlantoaxial rotatory subluxation in children. J. Am. Acad. Orthop. Surg. 2015 Jun; 23 (6): 382–392. https://doi.org/10.5435/JAAOS-D-14-00115.

5. Lee S. J., Han J. D., Lee H. B., Hwang J. H., Kim S. Y., Park M. C., Yim S. Y. Comparison of clinical severity of congenital muscular torticollis based on the method of child birth. Ann. Rehabil. Med. 2011 Oct; 35 (5): 641–647. https://doi.org/10.5535/arm.2011.35.5.641.

6. Kim H. J. Cervical spine anomalies in children and adolescents. Curr. Opin. Pediat. 2013 Feb; 25 (1): 72–77. https://doi.org/10.1097/MOP.0b013e32835bd4cf.

7. Parikh S. N., Crawford A. H., Choudhury S. Magnetic resonance imaging in the evaluation of infantile torticollis. Orthopedics. 2004 May; 27 (5): 509–515.

8. Boyko N., Eppinger M. A. Straka-DeMarco D., Mazzola C. A. Imaging of congenital torticollis in infants: a retrospective study of an institutional protocol. J. Neurosurg. Pediat. 2017 Aug; 20 (2): 191–195. https://doi.org/10.3171/2017.3.PEDS16277.

9. Lowe L. H., Johanek A. J., Moore C. W. Sonography of the neonatal spine: part 1, Normal anatomy, imaging pitfalls, and variations that may simulate disorders. Am. J. Roentgenol. 2007 Mar; 188 (3): 733–738. https://doi.org/10.2214/AJR.05.2159.

10. Lee K., Chung E., Koh S., Lee B. H. Outcomes of asymmetry in infants with congenital muscular torticollis. J. Phys. Ther Sci. 2015 Feb; 27 (2): 461–464. https://doi.org/10.1589/jpts.27.461.

11. Park H. J., Kim S. S., Lee S. Y., Lee Y. T., Yoon K., Chung E. C., Rho M. H., Kwag H. J. Assessment of follow-up sonography and clinical improvement among infants with congenital muscular torticollis. Am. J. Neuroradiol. 2013 Apr; 34 (4): 890–894. doi: 10.3174/ajnr.A3299.

12. Абдуллаев Р. Я., Шармазанова Е. П. Возможности рентгенологического и ультразвукового методов диагностики ротационного подвывиха атланта у детей. Лучевая диагностика, лучевая терапия 2014; 4: 56–62. Abdullaev R. Ya., Sharmazanova E. P. Possibilities of x-ray and ultrasound methods for diagnosing rotational subluxation of atlanta in children. Променева діагностика, променева терапія 2014; 4: 56–62.