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7 Criteria for Diagnosing Cranial Cervical
Instability

It happened so quickly. The light was red and the traffic was
stopped.  Then the SUV rear-ended you.  The headaches and dizziness
are constant and have not responded to care.  Your doctor is
puzzled as all your tests are normal.  What is Craniocervical
Instability – or Cranial Cervical Instability?  What is the Alar
Ligament?  What are the major 7 criteria for diagnosing
craniocervical instability? What is the PICL procedure?  Let’s
dig in.

What Is Cranial-Cervical Instability (CCI)?

Cranial Cervical Instability (CCI) is a medical condition where
the strong ligaments that hold your head to your upper neck are
loose or lax (1). The major ligaments involved are the Alar,
Transverse and Accessory ligaments.   To learn more about CCI
please click on the video below.

img

 

What Is the Alar Ligament?Alar Ligament Illustration Larger - Diagnosing Craniocervical Instability

Ligaments are thick bands of connective tissue
that connect one bone to another.  The Alar ligament 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
stability for your head and neck.

 

Diagnosing Cranial-Cervical Instability: 7 Main Criteria

The correct diagnosis is critical for the best clinical
outcome.  Diagnosing craniocervical instability involves 7 main
criteria which include:

Mechanism of Injury (How Did It Occur)

Understanding how and when the injury occurred is important. 
The two most common causes of Cranial Cervical Instability
(CCI) are trauma
and medical conditions that cause people
to have loose or compromised ligaments (2). Motor vehicle
accidents, contact sports, and forceful manipulations by
chiropractors are the most common examples of trauma.  Ehlers
Danlos Syndrome (EDS) is a group of inherited disorders that affect
your ligaments and connective tissues (2).

Symptoms

The symptoms associated with CCI can be extensive depending upon
the severity of the instability.  The most common symptoms
include:

HeadachesMigraines? That can help in Diagnosing Craniocervical Instability

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.

Upper 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, or behind the eyes.

Dizziness

Balance disturbances vary in severity and can make a simple walk
down the hall almost impossible at times.

Visual Disturbances

Loss of visual acuity, blurred vision, and changes in peripheral
vision can be some of the symptoms in patients with CCI
(3).brain fog? that can help your doctor in Diagnosing Craniocervical Instability

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.

 

Physical Examination

In the age of managed care and 15-minute appointments, the art
and practice of physical examination by a physician is almost
gone.  At the Centeno
-Schultz Clinic
all new patient evaluations undergo an
extensive physical examination. Why? It is important to view the
body as a whole and there are multiple potential physical findings
in the neck, head, shoulder, and low back in patients with cranial
cervical instability,

Radiographic Studies

There are various types of radiographic studies which include
x-ray, CT scan, and  MRI.  Unfortunately, traditional MRI and CT
studies do not evaluate the upper cervical spine or alar and
transverse ligaments. Special radiographic studies are required
which include upper cervical MRI or
rotatory CT scan.  In addition, there are
additional studies that involve the patient moving during the
examination.  These studies are useful to identify instability. 
Examples include upright MRI with upright
flexion/extension.  to see how this works please click on the video
below.

img

 

Finally, a Digital Motion X-ray (DMX)  is
important in establishing the diagnosis of CCI.  This is an x-ray
examination that is recorded in which the patient is put through
various movements including bending the neck forward, backward, and
to the side.  To learn more about DMX please click on the video
below.

img

 

 

Response to Conservative Care

The common symptoms of CCI can also arise from different
clinical conditions. For example, headaches with dizziness may
arise from tight or contracted neck muscles.  It is important that
patients undergo conservative care such as rest, heat, stretching,
physical therapy, massage, and chiropractic care.  In some cases,
symptoms improve with conservative therapy.

Response to Diagnostic Injections

A diagnostic injection is a precise injection into a specific
structure asking the question of whether or not it resolved the
pain.  Often times this is very helpful in the evaluation of
patients with CCI. All diagnostic injections are performed under
ultrasound or x-ray or both.  Examples of diagnostic injections
include:

  • C0-1 and C1/2 facet injections
  • Occipital nerve blocks
  • Superficial Cervical Plexus Blocks
  • Ligament injections

Level of Disability

In many cases due to the severity of the symptoms patients are
not able to complete their domestic or professional
responsibilities.  In severe cases of CCI, patients are confined to
their homes and are socially isolated. The level of disability is
important in diagnosing craniocervical instability (CCI).

 

Percutaneous Implantation of Cervical Ligaments Procedure – The
“PICLâ€

In 2015 a nonsurgical treatment option for cranial cervical
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 alar, 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.

img

 

In Conclusion

Cranial Cervical Instability (CCI) is a medical condition where
the strong ligaments that hold your head to your upper neck are
loose or lax.  The 7 criteria used in diagnosing craniocervical
instability include the mechanism of injury, symptoms, findings on
physical examination, radiographic studies, response to
conservative care and diagnostic injections, and level of
disability.  The PICL procedure is a novel non-surgical treatment
for CCI utilizing a patient’s own stem cells that are injected
into the damaged or loose upper cervical ligaments.  The procedure
allows patients to avoid the serious risks and complications
associated with surgery.

If you or a loved one sustained an injury and have symptoms that
include headache, dizziness, and brain fog which is unresponsive to
conservative care you may have cranial cervical instability. 
Schedule an in-office or telemedicine consultation with a
board-certified, fellowship-trained physician to determine if the
criteria for cranial cervical instabillity are met.  Act now before
the injury and symptoms progress which limits your options.

 

 

Want to Know More?  Request an Info Packet to
learn more about our procedures.

First Name *
Last Name *
Phone
Your Email *
 
Submit

 

 

 

References

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.Sobey G. Ehlers-Danlos
syndrome – a commonly misunderstood group of conditions
. Clin
Med (Lond). 2014;14(4):432-436.
doi:10.7861/clinmedicine.14-4-432

3.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

 

The post
7 Criteria for Diagnosing Cranial Cervical Instability
appeared
first on Centeno-Schultz
Clinic
.

It happened so quickly. The light was red and the traffic was
stopped.  Then the SUV rear-ended you.  The headaches and dizziness
are constant and have not responded to care.  Your doctor is
puzzled as all your tests are normal.  What is Craniocervical
Instability – or Cranial Cervical Instability?  What is the Alar
Ligament?  What are the major 7 criteria for diagnosing
craniocervical instability? What is the PICL procedure?  Let’s
dig in.

What Is Cranial-Cervical Instability (CCI)?

Cranial Cervical Instability (CCI) is a medical condition where
the strong ligaments that hold your head to your upper neck are
loose or lax (1). The major ligaments involved are the Alar,
Transverse and Accessory ligaments.   To learn more about CCI
please click on the video below.

img

 

What Is the Alar Ligament?Alar Ligament Illustration Larger - Diagnosing Craniocervical Instability

Ligaments are thick bands of connective tissue
that connect one bone to another.  The Alar ligament 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
stability for your head and neck.

 

Diagnosing Cranial-Cervical Instability: 7 Main Criteria

The correct diagnosis is critical for the best clinical
outcome.  Diagnosing craniocervical instability involves 7 main
criteria which include:

Mechanism of Injury (How Did It Occur)

Understanding how and when the injury occurred is important. 
The two most common causes of Cranial Cervical Instability
(CCI) are trauma
and medical conditions that cause people
to have loose or compromised ligaments (2). Motor vehicle
accidents, contact sports, and forceful manipulations by
chiropractors are the most common examples of trauma.  Ehlers
Danlos Syndrome (EDS) is a group of inherited disorders that affect
your ligaments and connective tissues (2).

Symptoms

The symptoms associated with CCI can be extensive depending upon
the severity of the instability.  The most common symptoms
include:

HeadachesMigraines? That can help in Diagnosing Craniocervical Instability

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.

Upper 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, or behind the eyes.

Dizziness

Balance disturbances vary in severity and can make a simple walk
down the hall almost impossible at times.

Visual Disturbances

Loss of visual acuity, blurred vision, and changes in peripheral
vision can be some of the symptoms in patients with CCI
(3).brain fog? that can help your doctor in Diagnosing Craniocervical Instability

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.

 

Physical Examination

In the age of managed care and 15-minute appointments, the art
and practice of physical examination by a physician is almost
gone.  At the Centeno
-Schultz Clinic
all new patient evaluations undergo an
extensive physical examination. Why? It is important to view the
body as a whole and there are multiple potential physical findings
in the neck, head, shoulder, and low back in patients with cranial
cervical instability,

Radiographic Studies

There are various types of radiographic studies which include
x-ray, CT scan, and  MRI.  Unfortunately, traditional MRI and CT
studies do not evaluate the upper cervical spine or alar and
transverse ligaments. Special radiographic studies are required
which include upper cervical MRI or
rotatory CT scan.  In addition, there are
additional studies that involve the patient moving during the
examination.  These studies are useful to identify instability. 
Examples include upright MRI with upright
flexion/extension.  to see how this works please click on the video
below.

img

 

Finally, a Digital Motion X-ray (DMX)  is
important in establishing the diagnosis of CCI.  This is an x-ray
examination that is recorded in which the patient is put through
various movements including bending the neck forward, backward, and
to the side.  To learn more about DMX please click on the video
below.

img

 

 

Response to Conservative Care

The common symptoms of CCI can also arise from different
clinical conditions. For example, headaches with dizziness may
arise from tight or contracted neck muscles.  It is important that
patients undergo conservative care such as rest, heat, stretching,
physical therapy, massage, and chiropractic care.  In some cases,
symptoms improve with conservative therapy.

Response to Diagnostic Injections

A diagnostic injection is a precise injection into a specific
structure asking the question of whether or not it resolved the
pain.  Often times this is very helpful in the evaluation of
patients with CCI. All diagnostic injections are performed under
ultrasound or x-ray or both.  Examples of diagnostic injections
include:

  • C0-1 and C1/2 facet injections
  • Occipital nerve blocks
  • Superficial Cervical Plexus Blocks
  • Ligament injections

Level of Disability

In many cases due to the severity of the symptoms patients are
not able to complete their domestic or professional
responsibilities.  In severe cases of CCI, patients are confined to
their homes and are socially isolated. The level of disability is
important in diagnosing craniocervical instability (CCI).

 

Percutaneous Implantation of Cervical Ligaments Procedure – The
“PICLâ€

In 2015 a nonsurgical treatment option for cranial cervical
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 alar, 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.

img

 

In Conclusion

Cranial Cervical Instability (CCI) is a medical condition where
the strong ligaments that hold your head to your upper neck are
loose or lax.  The 7 criteria used in diagnosing craniocervical
instability include the mechanism of injury, symptoms, findings on
physical examination, radiographic studies, response to
conservative care and diagnostic injections, and level of
disability.  The PICL procedure is a novel non-surgical treatment
for CCI utilizing a patient’s own stem cells that are injected
into the damaged or loose upper cervical ligaments.  The procedure
allows patients to avoid the serious risks and complications
associated with surgery.

If you or a loved one sustained an injury and have symptoms that
include headache, dizziness, and brain fog which is unresponsive to
conservative care you may have cranial cervical instability. 
Schedule an in-office or telemedicine consultation with a
board-certified, fellowship-trained physician to determine if the
criteria for cranial cervical instabillity are met.  Act now before
the injury and symptoms progress which limits your options.

 

 

Want to Know More?  Request an Info Packet to
learn more about our procedures.

First Name *
Last Name *
Phone
Your Email *
 
Submit

 

 

 

References

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.Sobey G. Ehlers-Danlos
syndrome – a commonly misunderstood group of conditions
. Clin
Med (Lond). 2014;14(4):432-436.
doi:10.7861/clinmedicine.14-4-432

3.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

 

The post
7 Criteria for Diagnosing Cranial Cervical Instability
appeared
first on Centeno-Schultz
Clinic
.

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