The upper cervical spine is said to be consist of two unique vertebrae, the atlas (C1) and the axis C2). The skull base with its bony and ligamentous elements surrounding the foramen magnum plays an integral part in maintenance of the normal functional alignment of these two cervical vertebrae.
Technically however, skull base is not a part of upper cervical spine.
But the injuries to upper cervical spine also include all osseous and ligamentous structures between the skull base and the cranial side of the C-3 vertebra.
The integrity of the craniocervical junction is of crucial for survival and function. It is here that transition from brainstem to spinal cord occurs. These vertebra are shaped different from rest of cervical spine to protect these vital structures and allow for mobility of the head .
An injury to osseoligamentous components in this region may therefore compromise structural integrity of the entire craniocervical junction and therefore needs to be addressed separately from rest of cervical spine.
Because of compex anatomy and a major role played by ligaments in stability, this region is quite vulnerable to injury in high energy trauma. This unique composition also makes the assessment difficult and aid of imaging studies becomes very important.
The assessment should be performed according to standard guidelines and should include cranial nerve examination. Prior to advent of trauma management systems, these injuries were almost always fatal but the survival has been improving with better management.
In conscious, oriented patients the symptoms of neck pain, headache, and
tenderness in the area might suggest the injury to this area.
Neurologic deficits range from complete high quadriplegia to incomplete injuries, such as cruciate paralysis or disorders affecting brainstem function.
Unconscious patients pose an increased diagnostic challenges and need to be scrutinized for possible spinal column and cord injury. The imaging studies play a greater role in these cases.
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About Dr Arun Pal Singh
I had surgery to remove a substernal goiter several years ago. I have had pain, dizziness, tremors and visual distrubances ever since. I have been to numerous pain clinics resulting in no relief. Recently, I went to see an upper cervical chiropractor and he took x-rays that showed that my Atlas (C-1) was rotated 7 degrees. He has been trying to re-align it with no success. Whenever he does align me, I have terrible side effects including burning on both sides of my neck which travel down my spine, into my legs, all the way to my ankels. My shoulders, arms and face also burn. He is definitely stimulating my nervous system, but it is not helping. He believes that the position of my neck during the surgery caused my Atlas to rotate and my cervical vertebre is irritating my sympathetic nervous system. If he is correct, is there anyway to correctly diagnose the rotation of my Atlas using radiographic techniques and do you have any suggestions of treatment for my symptoms.
Dr Arun Pal Singh Reply:
January 26th, 2010 at 9:39 am
@Cindi Larouche,
What is being told to you does not make much sense. It is quite difficult to make on xrays that atlas or any other vertebrae has rotated unless the rotation is substantial.
Only way to confirm is to get a better investigations like CT.
I am surprised that somebody suggested that one can realign vertebra manually.
It is something that is difficult do even during the surgery.
Position during the surgery cannot cause change in the vertebral alignment. It does not happen like that. Our body is quite strong to bear all this. Otherwise, one would have problems every morning after sleep.
So I do not understand what is being done.
Moreover, do not put yourself at risk with getting your neck maneuvered.
I have seen very bad outcomes of neck manipulations.
What should you do
Visit your doctor and tell him about the symptoms. Get investigated and diagnosed.
However, if you still want to investigate your atlas rotation, a CT would help.
Please explain what an ununited dens, or os odontoideum, with a result of stenosis of the carniocervical junction. What can be done if anything also how serious is this. I had a c1-c2 fracture in the past,currently have cerclage wiresfusing that area. any help at all would be greatly appreciated.
Dr Arun Pal Singh Reply:
August 28th, 2010 at 9:48 pm
@Michele Humbertson,
Please go through this article
http://boneandspine.com/spine/cervical-spine/what-is-os-odontoideum/