Upper Cervical Instability Evaluation in Murray, Utah

The upper cervical spine includes the base of the skull and the first two cervical vertebrae: the occiput at the base of the skull, the atlas (C1), and the axis (C2).

Unlike the lower cervical vertebrae, the atlas and axis permit a substantial amount of head rotation and do not depend on an intervertebral disc for stability. Their movement is controlled by joint anatomy, muscles, joint capsules, and ligaments such as the transverse and alar ligaments.

“Upper cervical instability” is a broad term. It may be used to describe abnormal movement involving the skull, atlas, or axis, but it is not one single diagnosis.

Related diagnoses can include:

• Atlantoaxial instability involving C1 and C2
• Craniocervical instability involving the skull and upper cervical spine
• Upper cervical ligament injury
• Abnormal rotational or translational motion
• Instability associated with trauma, inflammatory disease, congenital abnormalities, or connective-tissue disorders

These conditions require different diagnostic criteria and may require very different treatment or referral decisions.

Symptoms associated with an upper cervical disorder vary considerably and are not specific to instability. Depending on the individual, they may include:

• Persistent pain at the top of the neck
• Suboccipital pain at the base of the skull
• Headaches that appear to originate from the neck
• Pain or marked restriction with head rotation
• A feeling that the head is unusually heavy or difficult to support
• Muscle guarding or spasms around the upper neck
• Dizziness or disequilibrium associated with neck movement
• Symptoms that began or worsened following whiplash or another injury
• Neurological symptoms requiring further investigation

Headache, dizziness, brain fog, tinnitus, visual disturbance, or facial pain can have many possible causes. Their presence does not establish that the cervical spine is unstable.

The purpose of an evaluation is to investigate the pattern—not to force every symptom into an upper cervical diagnosis.

Further evaluation may be appropriate when symptoms:

• Began after an auto collision, sports injury, fall, or other trauma
• Persist despite previous treatment
• Consistently worsen with particular neck movements or positions
• Include a marked feeling of upper-neck weakness or poor head support
• Are accompanied by recurring cervicogenic headaches
• Do not match the findings from a routine static examination
• Raise concern for ligament injury or abnormal cervical motion
• Occur in someone with a condition associated with instability

A history of trauma alone does not prove ligament instability. Likewise, a normal static X-ray does not answer every question about how the neck moves. The history, examination, imaging findings, and overall clinical presentation must be interpreted together.

A comprehensive evaluation begins with a detailed history. Dr. Woodmansee will review the onset of your symptoms, previous injuries, neurological complaints, aggravating movements, earlier imaging, and response to prior care.

Upper-neck pain, headache, dizziness, and neurological complaints can overlap with many other conditions, including:

• Cervicogenic headache
• Headaches and migraines
• Concussion or post-concussion symptoms
• Vestibular disorders
• Cervical disc injury
• Cervical radiculopathy
• Degenerative joint disease
• Myofascial pain
• Connective-tissue disorders
• Vascular or neurological disease

Treating every person with these symptoms as though they have instability can lead to inappropriate care. Conversely, failing to recognize meaningful abnormal motion can also delay appropriate management.

The goal is to identify the most defensible explanation for the patient’s presentation and then determine the safest next step.

Treatment depends on the diagnosis, severity of the findings, neurological status, and suspected source of the symptoms.

When conservative care is appropriate, a plan may include:

Some patients require evaluation by a neurologist, neurosurgeon, orthopedic specialist, vestibular specialist, rheumatologist, geneticist, or another medical provider.

Surgical evaluation may be necessary when there is significant neurological compromise, radiographically established instability, progressive symptoms, or failure of appropriate conservative management.

Our responsibility is not to keep every patient in chiropractic care. It is to help determine what level and type of care is appropriate.

Our evaluation may be especially helpful if you:

• Have persistent or recurring symptoms following a neck injury
• Have received care without a clear explanation for your symptoms
• Suspect that abnormal cervical movement has not been adequately evaluated
• Want objective measurements rather than a symptom-only treatment plan
• Need help determining whether conservative care is reasonable
• Want a provider who will refer or co-manage when findings fall outside the appropriate scope of care