“My neck pain is excruciating and getting worse!”
“I’ve started having severe migraine headaches which I’ve never experienced before!”
“I can’t think straight anymore. I remember things from the past but I can’t focus on today…and I’m forgetting simple important tasks.”
“I have been to numerous health providers, including medical doctors, surgeons, and chiropractors and they all say there is nothing they can do to help, because there is nothing wrong with me!”
If you are experiencing these debilitating symptoms, and more, it is likely you have a condition known as Atlantoaxial Instability or AAI. This is another name for instability of the upper two cervical vertebrae in your neck, called C1 – the Atlas – and C2 – the Axis.
It is likely you have sustained trauma to your cervical or neck spine, usually from a motor vehicle collision – even a low speed crash. This is called a WHIPLASH INJURY.
What is Atlantoaxial Instability (AAI)
You may have heard the term, Atlantoaxial Instability and why is it associated with a spectrum of the major debilitating complaints – likely ruining your life, including your career, education, family relationships, and enjoyable activities.
The cervical spine consists of seven vertebra, on top of which sits your skull and its contents – the brain – altogether weighing about 12 pounds.
The Cervical vertebrae form a canal or tunnel in which is located your spinal cord and critical blood vessels called the vertebral arteries. The spinal cord is your lifeline transmitting information to and from your brain and controlling all movements and the functions of your organs.
The seven vertebra are labelled C1 through C7. Located between the vertebra below C2 are the Cervical discs. These are fifty-cent size circular ligament shock absorbers and joints holding the Cervical vertebra in alignment.
Together with other ligaments of the spine, the Cervical spine – your neck – can bend in all directions. However, the degree of motion is limited by these supporting structures in order to prevent them from slipping out of alignment. This is called Stability.
Leading Causes of Atlantoaxial Instability
- Sports injuries
- ATV accidents
- Slips and falls
- Physical trauma
- and many others
Other Potential Causes of Atlantoaxial Instability
- Congenital abnormalities, such as Ehler-Danlos Syndrome (EDS), Down’s Syndrome, and others
- Arthritic conditions, especially Rheumatoid Arthritis
- Infections, especially Lyme disease
Symptoms of Atlantoaxial Instability
Now we can explain your symptoms – together which are known as the Cranio-Cervical Syndrome.
Severe neck pain follows the ligament injuries, in turn, followed by the onset of severe pounding migraine headaches due to pressure on the vertebral arteries and brainstem.
Along with this comes a terrific difficulty in focusing and performing even the simple tasks of daily living. We call this Brain Fog. This is not a brain injury. Rather, it is a dynamic dysfunction of the Brainstem’s role in focus and attention to short term tasks and memory.
Diagnosing Atlantoaxial Instability
The problem you have been facing is that diagnosing AAI is difficult. The proper diagnosis can only be achieved by two studies. One is a video fluoroscopic view of your Cervical spine in motion called a DMX (Digital Motion X-ray) and the other is a special kind of MRI called an Upright Positional MRI.
Analyzing these studies is difficult and time consuming. Our expertise lies in a careful evaluation of your history and symptoms, followed by a comprehensive Medical and Neurosurgical examination. We then review these imaging studies with you in person. We will typically spend two to three hours with you, initially by Zoom Telemedicine ( if you are from out of state) and, then in our face to face office visit.
Atlantoaxial Instability Treatment
The great news is that we offer a permanent solution to your debilitating symptoms. This involves an outpatient surgical procedure restoring stability to C1 and C2 and permanently eliminating AAI, without causing any significant limitation in neck movement.
We are unique in offering this solution – perhaps only five other Neurosurgeons in the world have an interest in this area of the Cervical spine.
Why is Stability Important?
If the cervical vertebrae slip out of alignment then critical damage to the spinal cord can occur with devastating consequences.
This leads us to discuss AAI – instability of the upper two cervical vertebra C1 and C2. The structure of these vertebra is unique. C2 has a vertebral body, like all the others, however, protruding from the top is a bone pivot, almost looking like a finger, called the Odontoid or Dens. C1 sits on top of C2. However, there is no disc between them. Instead C1 is a ring of bone rotating around that C2 pivot – the Odontoid. In turn, the skull base – the occiput – lies on C1.
There is a “division of labor” in the upper Cervical spine – the lower skull or occiput flexes and extends on top of C1. C1 rotates on C2. These structures are kept in stable alignment by several small but incredibly strong ligaments including the transverse and altar ligaments.
The base of the brain called the brainstem and is crucial to all neurologic function. It is located in the skull base – the occiput – and connects to the spinal cord which descends into the spinal canal starting at C1-C2. The blood supply to the brainstem consists of two vertebral arteries running from the heart up along the cervical spine all the way to C1. These arteries curve over the arch of C1 and enter the skull and brainstem.
You can see, therefore, that the Stable relationship between C1 and C2 is critical. If these ligaments are injured, for example, in a Whiplash injury then C1 and C2 can slip out of alignment causing pressure on the brainstem and upper spinal cord and on the vertebral arteries – supplying blood and oxygen to the brainstem.
After Atlantoaxial Instability Surgery
Upon undergoing this surgical procedure, it is highly likely your neck pain will be resolved, migraine headaches will be eliminated, and your brain function will be restored to normal with disappearance of the brain fog. The other Neurological complaints and deficits you have will be eliminated.
We have evaluated hundreds of patients and surgically treated over 200 patients from across the United States, Canada, Europe, the Middle East, the Caribbean, and even Vietnam and Hong Kong.
Your life will dramatically change for the better and you will be able to pursue your career, education, family life and enjoyable activities.
In short – We will give you your life back!
