ORIGINAL RESEARCH. Correlation Between Atlas Fossa Temperature Difference and the Blair Upper Cervical Atlas Misalignment

Transcription

1 ORIGINAL RESEARCH Correlation Between Atlas Fossa Temperature Difference and the Blair Upper Cervical Atlas Misalignment Todd Hubbard M.S., D.C. 1 & Kali Gillen D.C. 2 ABSTRACT Objective: To determine the correlation between the atlas fossa temperature difference (AFTD) and the atlas misalignment determined by the Blair upper cervical radiographic analysis. Methods: Patients at the Palmer Academic Health Center (AHC), who were scheduled to have Blair Upper Cervical radiographs taken, were asked to participate in this study by having had their atlas fossa temperature difference taken using the TyTron C3000. The atlas fossa temperature difference was then compared to the Blair radiographic atlas listing. Results: Nineteen subject s data were collected for the correlation between the AFTD and misalignment seen on the radiograph. The Phi coefficient for the AFTD compared to the atlas laterality showed a poor correlation of (95% CI: to 0.686), with a chi square=1.351; df=1 and p= The Phi coefficient for the AFTD compared to the side of misalignment seen on the radiograph also showed a poor correlation of (95% CI: to 0.616) with a chi square=0.460; df=1 and p= Conclusion: This study found a poor correlation between the AFTD and the laterality of the atlas misalignment seen on the Blair radiograph. Key Words: Vertebral subluxation, atlas fossa temperature, Blair Upper Cervical, adjustment, thermography, chiropractic Introduction Chiropractors have used skin temperature readings, known as thermography, for many years to determine the presence of vertebral subluxations. 1-3 Specifically, the Chirometer was introduced in 1953 by B.J. Palmer to measure the skin temperature of the atlas fossa, the skin between the temporal mastoid and the ear lobe. 4 Today, the Tytron scanner is used to record the temperature of the atlas fossa along with cervical and full spine paraspinal thermography analysis. 5 The autonomic nervous system controls skin temperature via vasoconstriction and vasodilation. 6,7 The body s temperature should be symmetrical from side to side, along the spine. 1,6 When a difference between temperatures exists, it is thought a subluxation may be present. 1,6 The bodies temperature should also be constantly changing and responding to the environment. 8 When a subluxation is present, this ability to adapt is compromised. 8 The atlas fossa temperature difference has been assessed to evaluate its use as an indicator for atlas laterality of the subluxation. 3 It has been theorized that the cold side of the atlas fossa correlates to the side of subluxation. 1.9 No research has been done which confirms this, especially with 1. Palmer College of Chiropractic, Davenport, IA 2. Private Practice of Chiropractic, Kalispell, MT Atlas Fossa Temperature J. Upper Cervical Chiropractic Research January 25,

2 radiographic analysis. There is a possibility that the lack of correlation may have to do with the radiographic analysis system. The Blair upper cervical chiropractic radiographic protocol for analysis of the atlas misalignment has shown substantial reliability inter (0.74 kappa) and intra-examiner (0.92 kapp) reliability. 10 The Blair radiograph used to analyze the misalignment of the atlas vertebrae (first cervical) is an oblique nasium radiograph known as the Blair protracto view. The patient is rotated so the central ray of the x-ray tube is directed straight down the long axis of the occipital-atlantal articulation. 10 This radiograph allows the observing chiropractor the ability to visualize the alignment between the occipital condyle and the atlas lateral mass. The right protracto view is used to analyze the right articulation and the left protracto view analyzes the left articulation. Dr. Blair theorized that when the atlas is in a subluxated state, the primary motion of the articulation is no longer directly anterior or posterior, as it rotates around the X axis. He stated that when the subluxation is present, the atlas will move forward or backward in an anterior-medial or posterior-lateral direction respectively, in line with either the left or right long axis of the condyle-lateral mass articulations; while a misalignment appears on the opposite articulation (Figure 1). 10 By exposing a nasium radiograph directly in line with the long axis of the occipital condyle atlantal lateral mass articulation (known as the occipital condyle convergence angle), the observer should be able to visualize any misalignment of the this articulation. If the atlas has misaligned along the right convergence angle, a misalignment will not be seen on the right protracto views, but will be seen on the left, as the atlas is pulled either medially or laterally compared to the occipital condyle. This study investigates the correlation between the atlas fossa temperature difference and the atlas misalignment determined by the Blair upper cervical radiographic analysis. IRB approval was obtained by Palmer College of Chiropractic. Methods Subjects at the Palmer Academic Health Center (AHC), who have had a chiropractic examination and were to receive Blair upper cervical treatment, ordered by their treating chiropractor, were asked to participate in this study. Once the subject had been identified, they were given an informed consent to read and sign if they chose to participate. Upon acceptance to be enrolled in the study, a case number was assigned to the subject and recorded on an enrollment form. The subjects were instructed to remove neckties, necklaces or anything else around their necks and to not touch their necks or atlas fossa area for 16-minutes. After the 16-minute acclimation period, the subjects received a cervical thermography scan with the TyTron C3000 (Titronics Research and Development (Tiffin, IA)). The infrared thermography scan and the atlas fossa temperature was measured. The atlas fossa temperatures were acquired by placing the Tytron scanner 90 degrees to the skin, ½ inch away from the atlas fossa area between the posterior ear and mastoid process of the right and left side of the subject. The Atlas Fossa Temperature Difference (AFTD) is calculated by subtracting the right and left temperature readings taken from the atlas fossa. The Tytron software reports the temperature difference by indicating the side that is warmer. 5 For example, a reading for the right and left fossas measuring 95.2 and 95.8 respectively, would yield an AFTD of 0.6L. The AFTD was recorded on a study document, along with the case number and the actual temperature of the right and left fossa. The participants Blair radiographic series that were taken on the same day as the atlas fossa temperature were analyzed for atlas misalignment or segmental dysfunction by a certified Advanced Instructor for the Blair Chiropractic Society. The atlas misalignment was determined by using the radiographic analysis protocols out for the Blair upper cervical chiropractic technique. 10 The analyzing doctor was blinded to the atlas fossa temperature readings for the patient before the Blair radiographs were analyzed and the Blair atlas segmental dysfunction listing was recorded on the study document. Data for comparing the correlation between the AFTD to the Blair atlas listing for the side of laterality observed on radiograph was calculated with the Phi coefficient. The Phi coefficient measures the association between two dichotomous variables. A Phi coefficient of closer to 1 represents a strong correlation. A Phi coefficient closer to 0 represents no correlation. The statistical calculations were determined by using the 2 by 2 table at Results This study received approval from the institutional review board at Palmer College of Chiropractic, Davenport IA. From March 30 th to October 31 st 2012, twenty-three subjects (16 females) agreed to participate in this study at the Palmer College Academic Health Center. Four subjects were excluded from the study. Three subjects had atlas misalignments seen on both the right and left Blair protracto view radiographs (producing an anterior misalignment with no distinction of laterality); and one subject had a zero degree AFTD where the right and left atlas fossa temperature readings were the same, producing no distinction of laterality for the AFTD. This left 19 subject s data to be collected for the correlation between the AFTD and misalignment seen on the radiograph. (Table 1) The Phi coefficient for the AFTD compared to the atlas laterality showed a poor correlation of (95% CI: to 0.686), with a chi square=1.351; df=1 and p= The Phi coefficient for the AFTD compared to the side of misalignment seen on the radiograph also showed a poor correlation of (95% CI: to 0.616) with a chi square=0.460; df=1 and p= Discussion This study showed a poor correlation between the AFTD and both the Blair atlas laterality and the side of misalignment seen on the Blair protracto view radiograph. Both comparisons were not statistically significant. The lack of correlation found in this study may be due to the anatomy visualized on the Blair protracto views and the anatomy of the misalignment itself. On the Blair radiographs, the right protracto view (oblique nasium) allows the observing chiropractor to determine the alignment of the right occipital condyle and atlas lateral mass. If a misalignment is seen, it is labeled for laterality, anteriority/posteriority and superiority/inferiority (Figure 2 and 2 J. Upper Cervical Chiropractic Research January 25, 2016 Atlas Fossa Temperature

3 Figure 3). The focus of the analysis is only on the right occipital-atlantal articulation (on the right protracto view), however there is a misalignment occurring at both the right and left articulations. For example, when the atlas is observed to be misaligned on the right articulation, it is also misaligned on the left, however, the left articulation misalignment is not visualized. The patient positioning of the Blair protracto view has the central ray of the x-ray tube focused directly along the long axis of the right or left occipital-atlantal articulation. An atlas that is in a misalignment position, which is visualized on the right protracto view, is not visualized on the left, even though a misalignment has occurred on the left articulation. This is because the left protracto view is a radiograph exposed directly along the long axis of the articulation. If the atlas is moving forward or backward along the left articulation, the observer will not be able to visualize the misalignment on the left protracto view. The misalignment will only be able to visualize the misalignment on the right protracto view, exposed with the x-ray tubes central ray directly in line with the patient s right convergence angle. Limitations Due to the small sample size of the study population, this study cannot be generalized to a larger population. The information in this study should only be analyzed and evaluated for the participants in this study. Conclusion This study investigated the correlation between the atlas fossa temperature difference (AFTD) and the occipital- atlantal misalignment visualized on the Blair protracto view. There was no statistical significance found for the poor correlation between the AFTD and the atlas misalignment or the AFTD and the side of misalignment seen on the Blair radiograph. References 1. Hart J, Owens EF Jr. Stability of paraspinal thermal patterns during acclimation. J Manipulative Physiol Ther 2004 Feb;27(2): Brown MD, Coe A, DeBoard TD. Mastoid fossa temperature imbalances in the presence of interference patterns: a retrospective analysis of 253 cases. J Vertebral Subluxation Res 2010: Seay C, Gibbon C, Hart J. Intraexaminer and interexaminer reliability of mastoid fossa readings using a temporal artery thermometer. J Chiropractic Med; 6(2): Quigley JR. Manual for the technique and use of the chirometer. Davenport, IA: Palmer College of Chiropractic; Hart J. Standard deviation analysis of the mastoid fossa temperature differential reading: a potential model for objective chiropractic assessment. J Chiropractic Med; 10(1): Guyton AC HJ. Textbook of Medical Physiology. 11th ed.; Hart J. Mastoid fossa temperature differentials & health perception. J Vertebral Subluxation Res /28:7p. 8. Hart J, Omolo B, Boone WR. Thermal patterns and health perceptions. Journal of the Canadian Chiropractic Association; 51(2): Brown A, Coe A, DeBoard T. Mastoid fossa temperature imbalances in the presence of interference patterns: a retrospective analysis of 253 cases. J. Vertebral Subluxation Res.2010: Hubbard T, Vowles B, Forest T. Inter and intra-examiner reliability of the Blair protracto-view x-ray: Examination of a chiropractic technique. J Chiropr Med 2010 June;9(2): Acknowledgments The author thanks Palmer College of Chiropractic Research Center for their support in the Research Honors program; The Palmer College Academic Health Center the use of the clinic and their patients in this study; and Dr. Hubbard for his guidance in this study. Atlas Fossa Temperature J. Upper Cervical Chiropractic Research January 25,

4 Figure 1 Figure 1: A schematic of the occipital condyles and foramen magnum (Black) and the atlas, first cervical (Red); as seen on the base posterior radiograph. The atlas has misaligned Anterior-Right-Superior (ASR) according to the Blair Upper Cervical Technique theory. Line A: The convergence angle of the left occipital condyle. An oblique nasium (Blair protracto view) radiograph, with the x-ray central ray directed along this line would not show a lateral movement between the condyle and lateral mass. Line B: The convergence angle of the right occipital condyle. Line C: Parallel to line B, marks the lateral edge of the atlas lateral mass. An oblique nasium radiograph, with the x-ray central ray directed along line B, will show lateral movement of the right lateral mass compared to the right occipital condyle. Figure 2 Figure 2: A right protracto view showing the right occipital atlas articulation. The arrow shows where the atlas has slipped lateral in relation to the occipital condyle. 4 J. Upper Cervical Chiropractic Research January 25, 2016 Atlas Fossa Temperature

5 Figure 3 Figure 3: A left protracto view showing the left occipital atlas articulation. The arrow shows that the atlas and the occipital condyle are in line with each other. Table 1 Data for all patients enrolled in the study, showing the atlas fossa temperature difference, side of cold temperature, the atlas misalignment seen on the radiograph, the side of laterality of the atlas misalignment, the side of the cold fossa temperature compared to the side of atlas misalignment and the side of the cold fossa temperature compared to the side of laterality of the atlas misalignment. Patient Fossa Side Misalignment Laterality Temp compared to Side of misalignment L ASL same LL LL R ASL-ASR R ASR same RR RR R ASL opp RL RR L ASR opp LR LR L ASR opp LR LR None ASR L ASL same LL LL R ASR same RR RR R ASL opp RL RL L ASL-ASR same R ASR same RR RR L PIR same LL LR L ASL same LL LL L ASL same LL LL L PIL opp LR LL R ASL opp RL RL R ASL opp RL RL R ASR-ASL opp L PIR same LL LR R PIL same RR RL R ASR same RR RR R ASR same RR RR Temp compared to Side of Laterality R=Right, L=Left, ASR= Anterior Superior Right, ASL= Anterior Superior Left, PIR= Posterior Inferior Right, PIL= Posterior Inferior Left, opp= opposite. Atlas Fossa Temperature J. Upper Cervical Chiropractic Research January 25,