Craniocervical Instability

The Vagus Nerve, Inflammation, and the Neck: How are They Connected?

In my traditional medical education, there were nerves and there was a phenomenon called inflammation, and the two were never interrelated. Inflammation happened because of trauma or a chemical pathway that went haywire in diseases like rheumatoid arthritis, and nerves were activated to retrieve information like the sensation or to tell a body part what…read more

How Does the Body Stabilize the C1-C2 Joint? The Role of the Alar Ligament

Readers: Please excuse this in-depth and very dense discussion of the C1-C2 joint. I am preparing a large case series of PICL patients for publication and began writing this as a paper to be submitted for publication, but I decided that some of the rubber meets the road mechanism of the unique way that the…read more

What is Intracranial Hypertension? What Does It Have to Do with the Neck?

Since we see many patients with neck pain and headaches, the topic of intracranial hypertension seems to be more common these days. So what is intracranial hypertension and what does it have to do with headaches? Is it caused by internal jugular vein (IJV) compression? What is IJV compression? Can neck problems make it worse?…read more

CCI and DMX: Can You Still Have Instability with a Normal DMX? What Is a False Negative?

You can’t beat movement-based imaging for finding Cervical Instability. However, all imaging has a false-negative rate. Let’s discuss that and learn about instability in the process. Let’s dig in. What Is Instability? If you had to choose a single concept of what goes wrong in the spine as the most important thing you should know,…read more

Headaches, Blind Men, and an Elephant

Headaches are one of the most confusing problems for patients searching for solutions. Like the elephant and the blind men in the famous parable, each medical specialty seems to have a completely different way of conceptualizing this problem. Let’s dig in. Blind Men and an Elephant This is the parable from Wikipedia: “The parable of…read more

Ultrasound of the Living Spinal Cord

This morning I would like to share a video of an ultrasound of the Spinal Cord. I happened on this unique view last year and I finally asked my assistant to save a video clip. Let’s dig in. What Is the Spinal Cord? The Spinal Cord is often thought of as the main bundle of…read more

Using Upright Cervical MRI to Diagnose CCI

Neck MRI is often an art and there are units that allow the patient to be imaged while sitting or standing. Today we’ll get into why these units can be very helpful and how that impacts the diagnosis of Craniocervical Instability or CCI. Let’s dig in. What Is CCI? CCI stands for Craniocervical Instability. That…read more

What Is Cervical Medullary Syndrome?

What happens when the neck bones impinge on the upper spinal cord and brain stem? This is called Cervical Medullary Syndrome. Let’s explore what this is and why it happens. Let’s dig in. The Background Anatomy The normal upper neck anatomy is unique in that nature has built in quite a bit of space around…read more