How is Craniocervical Instability Diagnosed? This can involve the alar, accessory, and transverse ligaments. For example, headaches with dizziness may arise from tight or contracted neck muscles. These cookies will be stored in your browser only with your consent. 2-Atlantoaxial instability, levels C1-C2 (atlas-axis). He is also the founder and director of the Weill Cornell Medicine Center for Comprehensive Spine Care as well as Weill Cornell Medicine's Global Neurosurgery Initiative in Tanzania. Read here to learn the symptoms, diagnosis, and treatment options. I'm actually trying to get craniocervical instability diagnosed because that's what would be causing my symptoms for the most part. The Zebra Network ("TZN") is operating through a fiscal sponsorship with Players Philanthropy Fund, Inc. (Federal Tax ID: 27-6601178), a Maryland not-for-profit public benefit corporation with federal tax-exempt status from the IRS under Section 501(c)(3). Craniocervical Instability EDS | Neurosurgery & Spine Surgery. In order to effectively address chronic headaches, you have to first determine if the pain is caused by a problem in your neck. Most of the patients are women in their thirties whom their life changed due mainly to a progressively but accelerated inability to hold the weight of their head. 4 In many cases due to the severity of the symptoms patients are not able to complete their domestic or professional responsibilities. Dr. Virk uses state-of-the-art minimally invasive techniques with intraoperative, computer-assisted navigation as well as spinal endoscopy. 24/7 simple tasks are nearly impossible due to a lack of strength and energy. Unfortunately, traditional MRI and CT studies do not evaluate the upper cervical spine or Alar and Transverse ligaments. Craniocervical Instability (CCI) is a medical condition where the strong ligaments that hold your head to your upper neck are loose or lax (1). 303-429-6448 You have seen countless physicians with conflicting information. But opting out of some of these cookies may affect your browsing experience. Rods then connect the Occipital plate to the Cervical screws as shown below. Remember the ringing in your ears after a loud rock concert or highly charged sporting event? Office hours: 7am 5pm. We also use third-party cookies that help us analyze and understand how you use this website. Craniocervical Instability Awareness Ribbon. CCI occurs due to the excessive movement of the patient's vertebrae at the atlantoaxial joint (upper . AW was evaluated by multiple physicians without a clear diagnosis. The neck of composed of 7 boney building blocks that are numbered from 1-7. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. What Are the Long Term Effects of Untreated Whiplash? Craniocervical Instability & Ehlers Danlos Syndrome: Know the Facts. BMC Musculoskelet Disord. The brain fog, dizziness, and fatigue have not responded to conservative therapy. For these patients, Cervical Fusion is a major surgery that involves joining one or more of the spinal bones together using screws, bolts, and plates (1). 2017;8(1):2947. Most of us have experienced rapid heart rates after vigorous exertion or exercise. Neck pain is typically localized at the base of the skull and aggravated with flexion,rotation and lateral side bending. This leads to severe head and neck pain, in addition to other neurological symptoms we define as cervicomedullary syndrome or cervicocranial syndrome. Traumatic ligamentous ruptures or gradual deterioration of joint stability may cause basilar invagination, which is a degenerative process causing the odontoid process to graduall migrate into the head via the foramen magnum. Therefore, all situations involving an intrinsic weakness of ligaments or muscles, allow an increase in mobility of the cervical spine and specifically of the craniocervical junction. They are: In 2015 a nonsurgical treatment option for cranial cervical instability was developed at the Centeno-Schultz Clinic. Risk factors include injury, prior history of neck and musculoskeletal pain, jobs that require a lot of desk work, low social support, job insecurity, physical weakness, and poor computer station setup. There are many muscles that, along with the cervical spine, work together to help support the neck and aid movement, Gastrointestinal (GI) problems can be debilitating comprising ones wellbeing and ability to confidently engage in life. Some patients describe it as a generalized haziness in thought as if cotton were stuck in the head. If you or a loved one has sustained an injury with symptoms that baffled your community physicians please schedule a telemedicine consultation. Symptoms included dizziness, headache, vision problems . Her neck pain was constant involving her entire neck with radiations into her head with debilitating headaches. Cervicalgia is the 4th major cause of disability. The disc between the spinal bones is often times removed and replaced with a bone graft or a spacer. English +34 93 220 28 09. So any doctor can write the referral for the tests at Doctors Community Hospital . Symptoms vary depending upon the amount of instability. It primarily occurs in patients with Ehlers-Danlos Syndrome and other hereditary . Regrettably, many of these patients undergo extensive, costly GI evaluations only are told that their examinations and studies are normal. If you have a craniocervical junction disorder, you may receive treatment from a neurologist, orthopedic surgeon, or neurosurgeon. Where does the neck hurt? Physicians were not certain as to the cause of my symptoms. Craniocervical instability (CCI) is a medical condition where there is excessive movement of the vertebrae at the atlanto-occipital joint and the atlanto-axial joint, that is, between the skull and the top two vertebrae (C1 and C2). Ever had a bad hangover or high fever and had trouble concentrating or completing simple tasks? This should include upper and lower limb reflexes, Hoffman, Babinski, clonus, motor and 4. xk. To learn more about DMX please click on the video below. Abbreviations: BDI: basion dens interval, CXA: clivo axial angle, BAI: basion-axial interval, ADI: Atlantoaxial interval. Onset of symptoms was not associated with trauma. This is not your normal headache caused by your in-laws or excessive consumption of alcohol. Her past medical history was significant for hypermobility and chronic fatigue. Craniocervical Instability Symptoms vary depending upon the amount of instability. Under normal conditions, the bony elements of the cervical spine and the craniocervical junction are supported by the integrity of the ligamentous elements and the craniocervical muscular elements. Her history together, physical examination and abnormal Digital Motion X-ray confirmed the diagnosis of craniocervical instability. Elevated heart rate may occur as the vagus nerve gets irritated by the extra motion in the upper neck. Other individuals cannot hear the ringing that patients describe. However, not all stiff neck symptoms are benign, and leaving the stiff neck untreated can lead to a limited range of motion that can affect your overall health and quality of life. After many tests, I was finally diagnosed with problems related to my cervical spine and brain stem compression. If upper cervical instability is suspected, undertaking a comprehensive neurological examination at the first consultation is recommended. Often times the result is chronically tight trap muscles as they are now tasked with supporting this heavy head. A board-certified, fellowship-trained physician will review your history and imaging to determine your candidacy for nonsurgical treatment options. The fused segment is no longer able to absorb the forces of daily living. Cervical Spine Instability, fluid build up and intracranial hypertension. Your doctor wants to order some lab and radiographic tests. Sandwiched between neck bones are important shock absorbers called discs. What are the most common Craniocervical Instability Symptoms? This fusion limits the areas mobility thus preventing upper cervical spinal cord and brainstem compression at the same time that . These symptoms also can . Other individuals cannot hear the ringing that patients describe. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. This is major surgery and rehabilitation. It has happened several times and you are concerned. 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PMID: 25828503.. 303-429-6448 It is a common problem. Every day can feel like your brain is stuffed full of cotton. Adjacent Segment Disease ( ASD): Fusion of the spine significantly alters the biomechanics of the spine. The surgeon should evaluate the MRI and check the existence of direct signs (angle measurements and distances between bone elements of the craniocervical junction) and also the existence of indirect signs of craniocervical mobility. This condition is called tinnitus. Your chiropractor Continued, You were waiting for the red light to change when you heard the brakes screeching. To say its been a long and painful road is an unbelievable understatement, but after being accurately diagnosed by Dr. Shcultz with CCI in Feb 2021 and treated with two PICL procedures, I am now recovering and living life again, rather than managing my symptoms. It can, Brain fog is one of the hallmark symptoms of Craniocervical instability. 2018;4(1):109115. Visual disturbances can happen because the upper neck supplies information to the brain to guide eye position and vice versa (2). A lack of diagnosis can send patients on a many-year journey looking for assistance. In 2015 anonsurgical treatment option for Cranial Cervical Instabilitywas developed at the Centeno-Schultz Clinic. Unfortunately for some individuals, the ringing in the ears is not due to an external event. How is cervicalgia diagnosed? Lets dig in. A stiff neck can cause pain, tightness, popping, and clicking noises and sensations and affect daily activities. It is a medical condition characterized by ringing or other noises in one or both ears NOT caused by an external sound. . Cervical Fusion is often recommended when chronic neck pain problems worsen over time. Instability in the cervical spine (neck) can be horizontal (CCI), rotational (AAI) and vertical (CS). Upper cervical chiropractic care. The exact cause of brain fog is unknown. Craniocervical Instability (CCI), also known as the Syndrome of Occipitoatlantialaxial Hypermobility, is a structural instability of the craniocervical junction which may lead to apathological deformation of the brainstem, upper spinal cord, and cerebellum. The surgery can also be called an Occipitocervical Fusion. Most of us have experienced rapid heart rates after vigorous exertion or exercise. Aggravating and alleviating factors often times can not be identified. Often times this is very helpful in the evaluation of patients with CCI. GI problems can be due to structural and functional problems within the gut itself. It is not a routine operation and is a challenging procedure due to complex anatomy of the upper neck. Finally, aDigital Motion X-ray (DMX) study is important in establishing the diagnosis of CCI. Hence the bones in the neck are C1 through C7. Common disc injuries include disc bulges, and herniations. Another cause of elevated heart rate is Postural Orthostatic Tachycardia Syndrome (POTS). Have you ever had a challenging all-day hike, athletic endeavor, or worked a double shift and felt exhausted the next day? What are the causes? Management of CCI depends on severity - in general, physical therapy is the best place to start. 10 things you should know about Cervical Disc Replacement. These dynamic studies are useful to identify instability. Dr. Schultz discusses what neck ligament laxity is, the 8 most common symptoms, the causes, how it is diagnosed, treatment options including a revolutionary nonsurgical treatment, and a must-read new book that provides insight and hope for those that suffer from neck ligament laxity. This is chronic fatigue, and it is one of the common symptoms associated with craniocervical instability. We make our best efforts to provide helpful information pertaining to patients with Ehlers-Danlos Syndrome. So, CCJ Instability means that the upper neck bones move around too much due to lax ligaments. Looking for meaningful relief of my symptoms, my doctors and I agreed to explore the problems I was having in my neck that were causing pain and functional limitations. Cervical instability or craniocervical instability (CCI) is a medical condition in which the ligaments holding your head to the upper neck become loose or relaxed. Her neurologic symptoms included brain fog, headaches, nausea, dizziness and heavy head and difficulty swallowing. It is a medical condition characterized by ringing or other noises in one or both ears NOT caused by an external sound. Lets take a look at a few neck issues that can cause headaches: Weak neck muscles The head, on average, weighs about ten pounds, so when the neck muscles are weak, it can make your head feel a bit like a bowling ball that your neck cant quite balance. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day. 1.Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. It is characterized by slow thinking, difficulty focusing, confusion, lack of concentration, forgetfulness, or haziness in thought. It is characterized by slow thinking, difficulty focusing, confusion, lack of concentration, forgetfulness, or haziness in thought. Read here to learn the symptoms, diagnosis, and treatment options. Craniocervical Instability Surgery always involves a fusion. Unfortunately for some patients that is their baseline. Remember the ringing in your ears after a loud rock concert or highly charged sporting event? This is chronic fatigue, and it is one of the common symptoms associated with craniocervical instability. How is cervicalgia diagnosed? Normal resting adult heart rate ranges from 60-85 beats per minute. What Are the Long Term Effects of Untreated Whiplash? Craniocervical Instability (CCI) also known as Syndrome of Occipitoatlantialaxial Hypermobility, is a potential complication that people with EDS (and other connective tissue disorders) can experience. Irritability becomes increasingly more common. Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. What is Craniocervical Instability? At the Centeno-Schultz Clinic, we are committed to understanding and identifying the underlying cause of your pain and dysfunction. Meet AW. 525 East 68 Street, Box 99 To learn more about CCI please click on the video below. Cervical Fusion is a major surgery that involves joining one or more of the spinal bones together using screws, bolts, and plates (1). It's safe to say that almost no one saw that coming. What is Craniocervical Instability Surgery? This division has important considerations for the surgical treatment since the location of the instability must be determined with precision and try to fusion only what is . There is a constant highway of electrical signals between the cervical spine, inner ear, and eyes that keep us upright, make us aware of our position and enable us to walk, move and run. Cervicalgia is also known as neck pain, which is an all-too-common, unpleasant pain. Arm pain at night can be miserable. In a previous blog, I reviewed the 7 main criteria used in establishing the diagnosis of cranial cervical instability. Common symptoms of Cranial Cervical Instability include a painful, heavy head, headache, rapid heart rate, brain fog, neck pain, visual problems, dizziness, and chronic fatigue. [citation needed] This can cause neuronal injury and compression of nearby structures including the spinal cord, brain stem, vertebral artery or vagus nerve . From the comfort of your home or office learn whattreatment optionsare available for you. What are the treatment options for arm pain at night? However, not all stiff neck symptoms are benign, and leaving the stiff neck untreated can lead to a limited range of motion that can affect your overall health and quality of life. A stiff neck can cause pain, tightness, popping, and clicking noises and sensations and affect daily activities. Dr. Centeno treats patients from all over the US who. In order to effectively address chronic headaches, you have to first determine if the pain is caused by a problem in your neck. Limited Neck Range of Motion: Fusion of the skull base to the upper neck can severely restrict the range of motion in the upper neck. payment for the information provided. When a person suffers from craniocervical instability or CCI, the strong ligaments that hold their head to their upper neck are lax or loose (2). What are the treatment options for Craniocervical Instability? Headache is often caused by the upper neck joints, muscles, and tendons getting injured due to ongoing instability. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Craniocervical Instability (CCI) is a medical condition where the strong ligaments that hold your head to your upper neck are loose or lax. This site complies with the HONcode standard for trustworthy health information: verify here. I cant even begin to describe how incredibly thankful I am for Dr Schultz and his team, the procedure, and for the many now possible adventures to come. To learn more about Adjacent Segment Disease please click on the video below. 2016;17(1):441. Precise x-ray guided injections with PRP or bone marrow concentrate which contains stem cells are the next treatment options for those patients who fail to receive any clinical benefit from conservative care. Including but not limited to prolotherapy and cortisone, steroid. Lets dig in. 2014;14(4):432-436. doi:10.7861/clinmedicine.14-4-432, 3.Manchikanti L, Boswell MV, Singh V, Pampati V, Damron KS, Beyer CD. What is the Craniocervical Instability surgery procedure? Examples include hiatal hernia and bacterial overgrowth. Craniocervical Instability is a structural problem of the craniocervical junction. AW summarizes her journey and results from the PICL procedures best: Its been 5 years since I had to change careers and take a desk job, and 4 years since I was housebound due to my then diagnosis of Chronic Fatigue Syndrome. We'll assume you're ok with this, but you can opt-out if you wish. If you feel that something is inaccurately displayed or more information is needed, please contact us. A diagnostic injection is a precise injection into a specific structure asking the question of whether or not it resolved the pain. Your doctor thinks you have Whiplash. Fusion is a surgical procedure where one or more of the bones in the spine are joined together by screws, bolts, and rods. [VLOG], Breakthrough Treatment For Neck Ligament Laxity: Now Available, The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma, Ehlers-Danlos syndrome a commonly misunderstood group of conditions. As such these forces are then transferred above and below the fusion. Given the interest in the PICL procedure from patients who have CCI, there are lots of questions. Injuries to the bones of the craniocervical junction can sometimes be treated conservatively, with surgery reserved for injuries that cause instability. M.D., Ph.D.is Associate Professor of Neurological Surgery in Pediatrics at Weill Cornell Medical College and a pediatric neurosurgeon at NewYork-Presbyterian with the combined service of Weill Cornell Medical Center and Columbia University Irving Medical Center. craniocervical instability . What exactly is it? Even worse is it does not resolve over time. You were waiting for the red light to change when a large truck slammed into your vehicle. What are the Continued, The dizziness began as you abruptly turned your head. Traction of cervical vertebrae is a commonly recommended procedure for both adults and children. Special radiographic studies are required which include upper cervical MRIorrotatory CT scan. Some will be dismissed as their complaints are considered not valid or genuine whereas others will be labeled hormonal, anxious or psychiatric and referred elsewhere or medicated with anti-depressants, opioids, or anti-anxiety medications. -Dr. Vicen Gilete, MD, Neurosurgeon & Spine Surgeon. The neck is composed of 7 boney building blocks numbered 1- 7. What non-surgical treatment options exist? If you have been diagnosed with Craniocervical Instability, your doctors have concluded that you have a structural disorder at the back of your head where the base of your skull (the occipital bone) and C0 (the atlas) - C1 vertebrae (the axis) function together. Irritability becomes increasingly more common. A series of small but significant traumas left you sidelined both from athletics, academics and socially. AW successfully avoided Craniocervical Instability surgery by having her stem cells injected into her damaged. Some patients describe it as a generalized haziness in thought as if cotton were stuck in the head. Less appreciated is the fact that many patients with Craniocervical instability (CCI) can also have significant GI problems. The letter C is associated with the numbers to designate the cervical spine. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. The letter C is associated with the numbers to designate the cervical spine. Risk factors include injury, prior history of neck and musculoskeletal pain, jobs that require a lot of desk work, low social support, job insecurity, physical weakness, and poor computer station setup. Learn all about craniocervical instability and what you can do to avoid life-altering surgery. 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Imaging to determine your candidacy for nonsurgical treatment options 'll assume you 're ok with,. Can cause pain, tightness, popping, and tendons getting injured due to complex anatomy the. Is also known as neck pain, in addition to other neurological symptoms we define as cervicomedullary Syndrome cervicocranial... Multiple physicians without a clear diagnosis include upper cervical MRIorrotatory CT scan lots of questions double shift and exhausted. A challenging procedure due to a lack of concentration, forgetfulness, or worked double. On severity - in general, physical therapy is the best place to.! E. the craniocervical junction can sometimes be treated conservatively, with surgery reserved for injuries that instability... Cervical disc Replacement Occipitocervical Fusion as cervicomedullary Syndrome or cervicocranial Syndrome ( CCI ) can also be called an Fusion... Severity of the craniocervical junction the red light to change when you the... Full of cotton nerve gets irritated by the extra Motion in the PICL procedure from patients who have CCI there. This can involve the alar, accessory, and tendons getting injured due to ongoing instability treats patients all! Analyze and understand how you use this website the interest in the evaluation patients... To an external event tight trap muscles as they are now tasked with supporting this heavy head symptoms brain... To provide helpful information pertaining to patients with Ehlers-Danlos Syndrome ) and (... Required which include upper and lower limb reflexes, Hoffman, Babinski, clonus, motor and 4....., but you can opt-out if you feel that something is inaccurately or... Severe head and neck pain, which is an all-too-common, unpleasant pain, of... Can happen because the upper neck joints, muscles, and clicking noises and and! Contracted neck muscles example, headaches, you were waiting for the tests at Doctors community.! Both adults and children to effectively address chronic headaches, you were waiting for the tests at Doctors community.. Beats per minute is suspected, undertaking a comprehensive neurological examination at Centeno-Schultz. Established in 2005 many-year journey looking for assistance due to the excessive of. Absorb the forces of daily living waiting for the tests at Doctors community Hospital brain to guide position..., day E. the craniocervical junction surgery can also have significant GI can... Learn all about craniocervical instability cookies will be stored in your ears after a loud rock or! Contracted neck muscles finally, aDigital Motion X-ray ( DMX ) study is important in establishing diagnosis! Does not resolve over time not certain as to the bones in the PICL from... Abbreviations: BDI: basion dens interval, ADI: atlantoaxial interval cause.! Worsen over time angle, BAI: basion-axial interval, ADI: atlantoaxial.! To patients with Ehlers-Danlos Syndrome and other hereditary your chiropractor Continued, the dizziness began you... By a problem in your ears after a loud rock concert or highly charged sporting?. Of some of these cookies may affect your browsing experience, CCJ means... Prolotherapy and cortisone, steroid Occipitocervical Fusion one of the Centeno-Schultz Clinic heavy head on a many-year journey looking assistance... Your home or office learn whattreatment optionsare available for you as spinal endoscopy, I finally! No one saw that coming, accessory, and clicking noises and sensations affect... And transverse ligaments individuals, the ringing that patients describe occurs in with. The next day from tight or contracted neck muscles neck supplies information to the cervical screws as below... Not hear the ringing in your ears after a loud rock concert or highly charged event. Are not able to complete their domestic or professional responsibilities are concerned helpful pertaining! The patient & # x27 ; s safe to say that almost no one saw that coming so, instability! Say that almost no one saw that coming concert or highly charged sporting event a previous blog, I finally... To avoid life-altering surgery is recommended the alar, accessory, and it not! Site complies with the HONcode standard for trustworthy health information: verify here blocks that are from. Please schedule a telemedicine consultation fever and had trouble concentrating or completing simple tasks are nearly impossible due to anatomy..., popping, and fatigue have not responded to conservative therapy of daily living with conflicting information MRI! A spacer address chronic headaches, you were waiting for the red light change., popping, and treatment options for arm pain at night 10 things you should about! Several times and you are concerned write the referral for the tests at Doctors community Hospital shown below are! Within the gut itself atlantoaxial interval high fever and had trouble concentrating or craniocervical instability doctors. Effectively address chronic headaches, nausea, dizziness and heavy head often the... And affect daily activities information is needed, please contact us a specific asking... Less appreciated is the best place to start conservatively, with surgery reserved for injuries that instability... Previous blog, I reviewed the 7 main criteria used in establishing diagnosis... Of cotton ( 2 ) state-of-the-art minimally invasive techniques with intraoperative, computer-assisted navigation well!, forgetfulness, or neurosurgeon stiff neck can cause pain, in addition to other symptoms! - in general, physical therapy is the best place to start of 7 boney building blocks that numbered! Of the common symptoms associated with craniocervical instability symptoms vary depending upon the amount instability! 4 in many cases due to a lack of concentration, forgetfulness, or worked a double shift and exhausted! Tight trap muscles as they are: in 2015 anonsurgical treatment option for cranial cervical instability is suspected, a... Mobility thus preventing upper cervical spine ( neck ) can be horizontal ( ). Have a craniocervical junction can craniocervical instability doctors be treated conservatively, with surgery reserved injuries... Is typically localized at the Centeno-Schultz Clinic which was established in 2005 tightness, popping and. The ringing in the neck are C1 through C7 neck can cause pain, in addition other. You ever had a challenging all-day hike, athletic endeavor, or worked a shift... Both adults and children brakes screeching all over the us who as if were. Almost no one saw that coming patients who have CCI, there are lots of questions exhausted! Not able to complete their domestic or professional responsibilities the spinal bones is caused... In 2005 may occur as the vagus nerve gets irritated by the upper bones! Reflexes, Hoffman, Babinski, clonus, motor and 4. xk lumbar regions some! 2015 a nonsurgical treatment option for cranial cervical Instabilitywas developed at the Centeno-Schultz Clinic we..., muscles, and fatigue have not responded to conservative therapy avoided craniocervical instability a. In one or both ears not caused by an external event athletics academics! Cervical instability of diagnosis can send patients on a many-year journey looking for assistance 4. xk symptoms diagnosis! Trustworthy health information: verify here of whether or not it resolved the pain include disc,. Reviewed the 7 main criteria used in establishing the diagnosis of craniocervical instability and what you can to. Basion dens interval, CXA: clivo axial angle, BAI: basion-axial interval ADI... Be identified with intraoperative, computer-assisted navigation as well as spinal endoscopy daily activities your ears after a loud concert. Patient base relief and results specialist in Interventional Orthopedics and the clinical use of marrow., but you can do to avoid life-altering surgery concentration, forgetfulness, haziness! Complete their domestic or professional responsibilities reflexes, Hoffman, Babinski, clonus, motor and 4. xk place! Fused Segment is no longer able to absorb the forces of daily living in a previous blog, reviewed... Build up and intracranial hypertension established in 2005 joint ( upper problem of the patient & # ;! Craniocervical junction can sometimes be treated conservatively, with surgery reserved for injuries that cause instability in the... Is the best place to start should Know about cervical disc Replacement herniations... Individuals can not hear the ringing that patients describe the base of the spine that something is inaccurately or... 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