Upper Neck Surgery: Maximally Invasive and Minimally Effective

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This has been an interesting few weeks when it comes to upper neck surgery. Because we developed the world’s only regenerative medicine procedure that can target CCJ instability, we see many patients who have taken many different paths in their care. Some patients end up getting an upper neck fusion and, regrettably, it seems like many of these patients still have problems after the surgery. Let’s review.

CCJ Instability

Your head is held on by strong ligaments. If these ligaments become injured or if you’re born with stretchy ligaments, the upper neck (also called the craniocervical junction) can move too much, a problem known as instability. This means that the upper neck joints, muscles, tendons, and nerves can get beat up and cause pain in this area or the head.

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The Lead-Up to Neck Surgery

Given that physical therapy is not very successful when there are loose ligaments in the upper neck, many patients try this and move on. Sometimes they will find an expert manual physical therapist. This can be either a highly trained physical therapist or a special chiropractor. In these cases, patients can find some temporary relief. However, when that doesn’t cure the issue, patients often look for other options. At this point they’re desperate, having lost everything they love to do and seeing how it destroys the lives of those they love. At that point, upper neck surgery enters the picture.

Upper Neck Surgery

Upper neck surgery, in this case, is almost always a fusion. This means that hardware (plates and/or screws) are placed into the skull and/or upper neck bones. There are two main types of upper neck surgery we see:

  • Plates and screws that fuse the skull down to C2 (on the left above)
  • Screws placed through the C1–C2 joint only (on the right above)

C1–C2 Facet Fusion

The idea behind this surgery is that the alar ligaments that provide the C1–C2 joint with side-to-side stability are stretched or partially torn. The goal of the procedure is to insert a screw through the C1–C2 joint to have the joint grow together with bone (fuse). This prevents any motion in the joint.

Theoretically, at first blush, this sounds like a good idea. The pain is caused by the joint moving too much, so if it doesn’t move, then the pain will go away! However, it’s not so simple. Let me explain.

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My Two C1–C2 Fusion Patients

If you read this blog, you know I write about what I see every day in the clinic. These past few weeks, I evaluated two patients who had C1–C2 fusions for CCJ instability. Neither had much relief from this high-risk procedure. Both had the same complication: the C1–C2 joint failed to fuse. This means that they have a screw now through the C1–C2 facet joint and the joint can still move.

Regrettably, this is a nightmare scenario. You have a screw sitting in a joint that has pierced through the cartilage and damaged the inside of the joint. This alone is all it would take for the joint to become arthritic. However, add on to that the fact that there is a screw that can move as the joint moves and can damage bone and cartilage, and these patients are in pain.

Even More Ridiculous…

In both of these patients, not all conservative care that was possible was done. Huh? You’re planning a major surgery that has a very high complication rate including death from the procedure and not everything that was possible short of surgery was done? Yep.

In these cases, the upper neck facet joints were never injected! Meaning, nobody had any idea if these patients could have been helped by just injecting some anti-inflammatory or platelet-rich plasma (PRP) into these upper neck joints. This, of course, would be a far less invasive approach.

In these two cases of nonfusion, at least one of these patients had pain in these joints and likely never needed this surgical procedure. However, now our focus will be injecting PRP, but now she has a screw that poked a hole in the joint and is just hanging out there damaging tissue. So whether we can heal these issues will remain to be seen. The screw may need to come out, or she may need more aggressive regenerative medicine techniques.

Our CCJ Stem Cell Procedure

We have pioneered a procedure to directly inject these damaged ligaments with stem cells. It’s a very technically challenging procedure, so we only offer it in the U.S. at out Colorado HQ. More on that procedure below in my video:

The upshot? I’ve now seen many cases of unsuccessful C1–C2 fusion. Frankly, the more hardware-intensive version also produces poor results. So should you get this procedure? Not until everything that can be done short of surgery has been done.

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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