It happened so quickly. The neck adjustment was abrupt with immediate onset pain and dizziness. The symptoms never resolved. Your doctor thinks you may have injured an important ligament in your neck. What is Craniocervical Instability? What is the Alar Ligament? What are the 8 most common Craniocervical instability symptoms? Who is at risk for Craniocervical instability? What are the Craniocervical instability treatment options? Are there effective nonsurgical treatment options? What is the PICL procedure? Meet JT. Let’s Dig in.
What Is Craniocervical Instability? (Laxity of Ligaments that Hold Your Head onto Your Neck)
Craniocervical instability (CCI) is a medical condition in which the strong ligaments that connect and stabilize the head and neck are loose or damaged (1). Loose or lax ligaments in turn can cause in excessive movement in the upper neck. The major ligaments involved are the Alar, Transverse and Accessory ligaments. Excessive movement in the upper neck can cause a number of symptoms that many health care providers have a very difficult time interpreting and understanding. Regrettably this often times results in misdiagnosis or the patient being dismissed as ” anxious” or “depressed”.
To learn more about CCI please click on the video below.
What Is the Alar Ligament?
Ligaments are thick bands of connective tissue that connect one bone to another. The Alar ligament is in the upper cervical spine and connects the upper neck to your head. There is a right and a left Alar ligament which is illustrated to the right. The alar ligament provides critical stability for your head, neck and spine.
What Does Craniocervical Instability Feel Like? (BAD!!)
Excessive movement between your head and neck can cause movement and damage of upper cervical facet joints, discs, nerves, and blood vessels. Symptoms vary depending upon the severity of the ligament instability. In general the greater the instability the greater and more severe the symptoms. The 8 most common symptoms of craniocervical instability include.
1. Painful, Heavy Head
A constant to near-constant head pain that can be described as feeling like the head is too heavy for the neck to support. Many describe feeling like they have a “bobble-head”.
2. Headache
This is not your normal headache caused by your in-laws or excessive consumption of alcohol. This is a debilitating headache that is constant in duration and miserable. Headache is often caused by the upper neck joints, muscles, and tendons getting injured due to ongoing instability.
3. Rapid Heart Rate
Elevated heart rate may occur as the vagus nerve gets irritated by the extra motion in the upper neck. Another cause of elevated heart rate is Postural Orthostatic Tachycardia Syndrome (POTS). POTS is a medical condition that causes malfunction of the autonomic nervous system. It is estimated to impact between 1,000,000 and 3,000,000 Americans. The autonomic nervous system controls involuntary body functions such as heart rate and blood pressure. Malfunction of the autonomic nervous system causes a number of symptoms which include rapid heart rate.
4. Brain Fog
Patients with CCI can struggle with memory, concentration, and ability to complete tasks. Every day can feel like your brain is stuffed full of cotton.
5. Neck Pain
Pain is typically localized at the base of the skull and aggravated with flexion and rotation. The pain can shoot up into the base of the skull, top of the head, frontal area or behind the eyes.
6. Visual Problems
Visual disturbances can vary from mild to severe involving a number of symptoms. Visual disturbances can happen because the upper neck supplies information to the brain to guide eye position and vice versa (2).
7. Dizziness
Balance problems can be a significant issue (3). Dizziness or imbalance is a feature related to the fact that the upper neck is a major contributor to balance (4). The upper neck provides position sense that has to be coordinated with balance information from the eyes and inner ear
8. Functional Compromise
As a result of the symptoms described above many patients with CCI are unable to complete their work and domestic responsibilities. They can become socially isolated and in severe cases are unable to leave their homes due to pain, headache and fatigue.
Who Is at Risk for Craniocervical Instability? (Trauma and Hypermobility)
Craniocervical instability can occur as a result of a number of different events or conditions. The four most common are:
Trauma
Classic examples include motor vehicle accidents, sports injuries, or forceful chiropractic adjustments (5). Some patients describe a traumatic injury followed by the immediate onset of neck pain, mental fog, and dizziness.
Inflammatory Conditions
Chronic inflammatory diseases can be debilitating. In such cases, a patient’s own immune system attacks itself resulting in inflammation, injury, and pain. Common examples include rheumatoid arthritis, scleroderma, and lupus. Patients with rheumatoid arthritis are at risk for Craniocervical Instability.
Congenital
Congenital disorders are also known as birth defects. There are many different types of birth defects which include cleft lip, cerebral palsy, and Down’s syndrome. Patients with Down’s syndrome are a risk for CCI (5).
Connective Tissue Disorders
There are a number of medical conditions where the ligaments are loose due to defects in the connective tissue. These patients have overly flexible joints that allow them to very, very flexible. Ehlers Danlos Syndrome is a classic example of such patients (7). There are thirteen different subtypes. Symptoms can vary depending upon the severity of the condition. Patients with EDS can easily bend their thumbs backward so that it can touch their forearms.
Ligaments are thick pieces of connective tissue that connect bone to bone. They also hold your head on to your neck. Loose or compromised ligaments in the upper neck can cause craniocervical instability.
Are There Craniocervical Instability Treatment Options? (Conservative, Posterior Injections, Surgery or PICL)
Yes! There are three major types of treatment options. The specific type of treatment will depend upon the amount of instability and severity of symptoms.
Conservative
Patients with small amounts of instability can oftentimes be managed with conservative care. Conservative treatment options would include:
1. Upper cervical chiropractic care. Look for members of NUCCA (National Upper Cervical Chiropractic Association)
2. Physical Therapy
3. Bracing
4. Curve restoration. Look for chiropractors that specialize: Chiropractic BioPhysics.
Posterior Neck Injections
If conservative care fails to provide clinical improvement the next step is x-ray guided injections into the upper neck (6). Specifically, this would include injections into the facet joints and upper cervical ligaments. Ligaments again are thick pieces of connective tissue that connect one bone to another. An example would be the interspinous ligaments that connect one vertebra to the next. The facet joint is a small joint on the backside of the spine that provides stability and limits movement. It is susceptible to injury and degeneration both of which can cause neck and headache pain. Injections would include both PRP and stem cells. Not all injections are the same. There can be significant differences between clinics and practitioners. Accurate needle placement requires the use of x-ray and contrast. Contrast otherwise known as dye demonstrates where the needle it is. This is critical because if the needle is not in the targeted joint, the injected PRP or stem cells will NOT magically get into the joint.
Some clinics deceive patients as they have an x-ray machine in the procedure room but do NOT use contrast. As a patient, demand that your procedures are performed with contrast. Without contrast, there is no way to confirm that the injected PRP or stem cells actually got into the targeted facet joint or ligament. Below is a recent x-ray image from the Centeno-Schultz Clinic demonstrating accurate placement of the needle in the C1/2 facet joint which is filled with contrast.
Surgery (Fusion of Head to Neck)
If conservative care and injections fail many patients are referred for surgery. There are many different types of surgical options all of which include Fusion. Fusion is a surgery that connects one or more segments of your spine together using screws, bolts and plates. The goal is to provide stability. The most common is a fusion of the head to the cervical spine. This is illustrated in the picture to the right. It involves multiple screws and rods that are placed into the skull and neck. The procedure is major surgery with significant risks which include eventual arthritis above and below the fusion, misplaced screws in nerves of facet joints, and failure of the bones to fuse (non-union). With this craniocervical instabiltity treatment, neck range of motion is permanently altered and in most cases severely restricted.
Stem Cell Upper Cervical Ligament Injections
In 2015 a nonsurgical treatment option for craniocervical instability was developed at the Centeno-Schultz Clinic. It involves the injection of a patient’s own bone marrow-derived stem cells into the damaged upper cervical ligaments. These include the Alar and Transverse ligaments. The procedure is very demanding and only performed at the Centeno-Schultz Clinic in Broomfield Colorado. The procedure is called Percutaneous Implantation of Cervical Ligaments (PICL) To learn more about this groundbreaking procedure please click on the video below.
Meet JT (Another Success Story)
JT is a 31 y/o mother of two from Australia who developed craniocervical instability after undergoing a high velocity chiropractic adjustment. During the adjustment she felt her neck snap with immediate onset of dizziness, brain fog and headache. In Australia she underwent a number of conservative treatments including rest, NSAID, oral medications, narcotics, physical therapy, and prolotherapy without significant or sustained results. Her past medical history was significant for hypermobility. She and her family were dramatically impacted. Prior to the injury she was a full time student with honor working part time. After the injury she was not able to continue with her studies or work. She traveled to the Centeno-Schultz Clinic in late 2019 where she presented with a 2 year history of neck pain which was constant, 7/10 in severity, localized in the upper neck with radiations into the back of her head as well as down between her shoulder blades. Her neck pain was accompanied with dizziness, brain fog, fatigue and headaches. After establishing the diagnosis of craniocervical instability JT declined surgery and opted to use her own stem cells with the PICL procedure. The results have been dramatic. Please listen to JT in the video below.
In Conclusion
Craniocervical instability (CCI) is a medical condition in which the strong ligaments that connect and stabilize the head and neck are loose.
Loose or lax ligaments can cause excessive movement in the upper neck.
Excessive movement in the upper neck can cause a number of symptoms that oftentimes are difficult for health care providers to understand and interpret.
The 8 most common symptoms of Craniocervical instability are:
- Headache
- Painful, heavy head
- Rapid Heart Rate
- Brain Fog
- Neck Pain
- Visual Problems
- Dizziness
- Functional Compromise
Craniocervical instability can occur as a result of trauma, Inflammatory conditions, birth defects and connective tissue disorders.
Craniocervical instability treatment options include
- Conservative Care
- Posterior Neck Injections
- Surgery
- Stem cells
The PICL (Percutaneous Implantation of Cervical Ligaments) is an advanced stem cell injection procedure pioneered at the Centeno-Schultz Clinic in 2015 where a patients own stem cells are injected into the damaged neck ligaments. It is an
effective, nonsurgical Craniocervical instability treatment option.
JT is a patient from Australia who has significant clinical benefit from this nonsurgical Craniocervical Instability treatment that is only offered at the Centeno-Schultz Clinic in Broomfield Colorado.
If you or a loved one suffers from Craniocervical instability or have sustained an injury with symptoms that baffled your community physicians, please schedule a telemedicine schedule a new patient consultation where you can learn what regenerative treatment options are best for you. We are experts in the field and will compassionately listen to you and your loved ones. Act now because if left untreated can result in a progression in symptoms and injury to the cervical discs, facets, muscles, and nerves
1.Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging. 2017;8(1):29–47. doi:10.1007/s13244-016-0530-5
2.Ischebeck BK, de Vries J, Van der Geest JN, et al. Eye movements in patients with Whiplash Associated Disorders: a systematic review. BMC Musculoskelet Disord. 2016;17(1):441. Published 2016 Oct 21. doi:10.1186/s12891-016-1284-4
3.Biesinger E. and Vertigo caused by disorders of the cervical vertebral column. Diagnosis and treatment. Adv Otorhinolaryngol. 1988; 39: 44– 51.
4.Thompson-Harvey A, Hain TC. Symptoms in cervical vertigo. Laryngoscope Investig Otolaryngol. 2018;4(1):109–115. Published 2018 Nov 28. doi:10.1002/lio2.227
5.Ashafai, Nabeel S.; Visocchi, Massimiliano; Wąsik, Norbert (2019). “Occipitocervical Fusion: An Updated Review“. Acta Neurochirurgica. Supplement. 125: 247–252. doi:10.1007/978-3-319-62515-7_35. ISSN 0065-1419. PMID 30610329.
6.Centeno CJ1, Elliott J, Elkins WL, Freeman M. Fluoroscopically guided cervical prolotherapy for instability with blinded pre and post radiographic reading. Pain Physician. 2005 Jan;8(1):67-72. https://www.ncbi.nlm.nih.gov/pubmed/16850045
