[kiluso22]

#28389

Hi,
I have confirmed rotary subluxation but the atlas goes back to centre. My c1/c2 facet entirely subluxation anteriorly during right sided rotation. I live in the UK and their knowledge on the cranial cervical junction is lacking to say the least. I suspect I have the torn Barkow ligament as I had traction with a sling in 2009 so have been living with this and the horrendous symptoms since then. loss of balance and lack of extension. No more than 5 degrees through the occiput.I have straightening of the cervical spine since this rupture.
My question is how would you go about diagnosing Occipital sliding or c1/c2 instability. My lack of extension gives it away with tearing of Barkow ligament. High signal around Alar ligament but still unconfirmed for occipital instability. The UK don’t have the diagnostic capability and rely on diagnoses when on the operating table when muscle guarding goes when asleep.
Do you use traction with an x ray to show occipital disassociation ?

[Donald Corenman, MD, DC]

#28391

It is uncommon to have both occiput-C1 and C1-2 become unstable but it has been reported. The Barkow ligament is a minor ligament (“This ligament appears to resist extension of the atlantooccipital joint and may be synergistic with the anterior atlantooccipital membrane”). Your lack of extension does not indicate a loss of this ligament. See https://neckandback.com/conditions/stabilizing-ligaments-upper-cervical-spine-occiput-c2/

With traction, you want to be careful if you truly have occipital-cervical disassociation. A slight traction maneuver (maybe 15-20 pounds) with your ability as the patient to immediately stop the traction if you feel anything amiss while taking a lateral X-ray could be helpful. If the X-ray tech is really good, they could provide manual traction while an X-ray is taken.

The full luxation of C1 on C2 could be demonstrated by a rotational CT scan (while you rotate your head to the side) which would be valuable information.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[kiluso22]

#28421

Thank you for the advice. It is complicated for me. With confirmed rotary subluxation ; prolapsed and diseased disk at c5/c6 with a buckled interspinous ligament at this level. Also buckled ligament flavum with a benign bone growth at c6 left facet.

So for me to have screw fixation which i was offered 4 years ago didn’t
seem a releastic option with the base of my neck fairly weak. More symptoms come from my mastoid area especially with flexion and extension with limited rotation. Question – would the pros out way the cons with screw fixation at c1/c2 with buckled lower neck and more importantly a very hyper mobile occiput ?

Not being able to run without projectile vomiting and severe muscle guarding and not being able to extend my neck now for 4 years since secondary tare on exercise ball i can only deduce that i also have instability of occiput as well. Lost 2 stone in weight. couldn’t walk for 2 months ; flat face ; stridor ; tinnitus and a world of pain that i have never experienced before.

4 years later and thousands of hours of rehab i’m still unable to do the basic things like look up. Surely in my posistion full C0 -C7 would be fusion would be more sensible than Co – C2 fixation ?

[Donald Corenman, MD, DC]

#28469

Don’t focus on “screw fixation”. The point of fusion is to get the two bony structures to grow into one mass. You have to get there by immobilizing these two structures. This is performed with rods and screws. As an alternative, you could be placed in a halo orthosis (body frame with screws into your head) for 6 months but no one wants that.

You don’t need a full fusion of your entire cervical spine. You would not be happy with the limited range of motion and this would be unnecessary.

You need a meticulous spine surgeon to carefully take a look at you, do the appropriate tests and sit down with you to explain what he or she is doing and why.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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