QuestionI am interested in knowing, any experience treating chairi 1 malformation with syrinx in cervical region with activator method.And if yes, then outcome , and experience with that.
AnswerThank you for your question.
I do not have personal experience with the use of the Activator instrument for spinal manipulation in the treatment of patients with Arnold-Chiari malformation and syringomyelia. However, with respect to the chiropractic treatment of patients with both Arnold-Chiari malformation (type I) and syringomyelia, there are two points of view that are worth mentioning.
According to the National Institute of Neurologic Disorders and Stroke, Chiari malformations are structural defects in the cerebellum, the part of the brain that controls balance. Normally the cerebellum and parts of the brain stem sit in an indented space at the lower rear of the skull, above the foramen magnum (a funnel-like opening to the spinal canal). When part of the cerebellum is located below the foramen magnum, it is called a Chiari malformation.
Type I involves the extension of the cerebellar tonsils (the lower part of the cerebellum) into the foramen magnum, without involving the brain stem. Normally, only the spinal cord passes through this opening. Type I malformation may not cause symptoms. It is the most common form of Chiari malformation and is usually first noticed in adolescence or adulthood, often incidentally during an examination for another condition. Type I is the only type of Chiari malformation that can be acquired.
With regard to Chiari malformations, syringomyelia and chiropractic treatment, the 2005 World Health Organization Guidelines on Basic Training and Safety in Chiropractic list both Arnold-Chiari malformation of the upper cervical spine and syringomyelia as absolute contraindications to spinal manipulative therapy.
A 2007 report on clinical practice guidelines in the Journal of the Canadian Chiropractic Association lists cervical spine myelopathy as an absolute contraindication to manipulation of the cervical spine. Myelopathy is an inclusive term referring to any disease of the spinal canal which typically results in neurologic signs and symptoms, such as impaired function, weakness of limbs, altered gait, abnormal reflexes, and unusual sensations in the hands or feet. Chiari malformations may be considered as a form of myelopathy. Again, Chiari type I malformations may not produce symptoms. Syringomyelia would also be considered as a form of myelopathy. The neurologic symptoms of syringomyelia are similar to that of Chiari malformations, when symptoms are present.
It should be noted that spinal manipulation/adjustments in these cases refer to thrust manipulations of the spine. Instrument-assisted manipulations, such as the Activator, are generally regarded as low-force, non-thrust manipulations.
On the other hand, a 1993 paper published in the Journal of Manipulative and Physiological Therapeutics presented two cases in which patients with Type I Arnold-Chiari malformation were treated with adjustments (manipulation) to the cervical spine for conditions unrelated to the anomaly. The patients reported were adjusted (manipulated) multiple times to the cervical spine. No ill effects or complications were noted related to the Arnold-Chiari malformation. The authors concluded that asymptomatic Type I Arnold-Chiari malformation is not necessarily a contraindication to skilled adjustments to the cervical spine. Again, these case reports refer to thrust manipulations of the spine.
With regard to your specific inquiry, general chiropractic clinical guidelines do not support spinal manipulative therapy for the treatment of Arnold-Chiari malformations or syringomyelia. Only a limited case study describes treatment of individuals with spinal manipulative therapy for symptoms unrelated to Arnold-Chiari malformations and syringomyelia. Therefore, a clinician deciding to treat a patient with Arnold-Chiari malformation and syringomyelia with spinal manipulative therapy must weight the potential risk versus benefit ratio.
I hope that this helps to answer your question.
