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Are You a Candidate for Our Novel CCJ Instability Procedure?

POSTED ON IN Neck/Cervical BY Chris Centeno

CCJ Instability

This past year we were the first clinic in the world to begin offering a first-of-its-kind direct stem cell treatment for the alar, transverse, and accessory ligaments that make up the craniocervical junction, or CCJ. Given that the only other option that seems to work for these CCJ instability patients is a very, very invasive surgery, we’ve had quite a few patients inquire about getting this therapy. However, given that this is a new and experimental procedure, we want to make sure that all of these patients understand what we require to pull the trigger on this treatment.

What Is the CCJ?

The CCJ is the area where the head meets the neck. Your bowling ball of a head is held onto your neck with strong ligaments and muscles. The ligaments can get damaged with direct trauma to the head or upper neck or in a car-crash “whiplash” type injury. These patients often have cracking or popping or even slipping sensations in this area. Almost all of them have some sort of headache, dizziness, brain fog, or other symptoms.

We have developed a novel procedure that is the first in the world of its type. This is very different than other procedures being offered that never reach these critical ligaments that are buried deep inside the spine.

The patient is put to sleep using a very unique anesthesia protocol that can help assist the accuracy of the procedure. We use a specialized scope to view the back of the throat and then place a specific type of oral appliance to keep the mouth open and that allows a fluoroscope X-ray beam to pass easily. After this area is thoroughly cleaned, we then use advanced X-ray guidance to place a thin needle through the natural gap between the C1 and C2 vertebrae and into the alar, transverse, and accessory ligaments. After we confirm with X-ray contrast that we’re in the right spot, we then inject our proprietary HD-BMC (a super-concentrated same-day stem cell mix) into the ligaments. To learn more watch the video.

Over the past year plus, we’ve performed about 35 of these procedures with minimal sequelae and good results. This is in a patient population that doesn’t seem to respond to anything else, including multiple traditional injection types, chiropractic care, physical therapy, and alternative treatments. We now perform several each month, so by the end of this year, we should have treated close to 100 patients.

Since there’s no other option for many of these CCJ instability patients other than a very invasive surgical fusion of the area, we’ve had tremendous interest in this new procedure. However, it’s important to note that since this procedure is experimental, we follow a rigorous protocol to decide who is a good candidate. Below is the method behind how we make that decision.

PLEASE NOTE THAT NO OTHER CLINIC OUTSIDE OF THE COLORADO REGENEXX CLINIC IS CURRENTLY AUTHORIZED OR CAPABLE OF PERFORMING THIS CCJ LIGAMENT PROCEDURE.

Deciding if You’re a Candidate for the Alar/Transverse/Accessory Ligament Procedure

  • Prior Response to Other Therapies: Many CCJ instability patients have a temporary response to upper-cervical chiropractic adjustments, but do poorly with other types of care, like traditional physical therapy. We believe that this positive response is a key factor in adding to the body of evidence that there is an upper-cervical-specific problem.
  • Prior Injection Care: We look closely at what the patient has already done with regard to prior injections. For example, many patients will have had prior prolotherapy or PRP injections to the back of their neck (posterior prolo or PRP). Some patients find this helpful, but if there’s a CCJ ligament problem, it usually doesn’t solve the problem. This technique involves injecting an irritant or concentrated platelets containing helpful growth factors into the ligaments. Both of these things can kick off an inflammatory healing cycle. However, please note that for us to consider that this type of medical care has failed and that the only next step is a CCJ injection, we must rule out that the actual upper-cervical facet joints and ligaments have been injected under guidance. Given that there are only a handful of physicians in any given large community in the U.S. who are qualified to inject these joints and ligaments, it’s very unlikely that most patients have had this therapy performed. Also please note that you may have been told by the doctor using a blind or ultrasound-guided technique that these joints were injected. Regrettably, this is not a true specific facet injection but an injection into the area of the facet without any confirmation that the joint was in fact injected. Hence, these procedures won’t count as having had what we require. We do offer these procedures at our Colorado office.
  • Symptoms and Exam Consistent with CCJ Instability: Upper-cervical symptoms tend to be headache, dizziness, imbalance, cracking or popping in the CCJ area, brain fog, and others. So we’ll want to see that you fit the patterns of symptoms that are common in CCJ instability patients. In addition, the exam performed by one of our physicians should be consistent as well.
  • Imaging: Having the right type of imaging that shows a problem in the upper-cervical ligaments is a key factor for us. The most common test we require is a DMX (Digital Motion X-ray). This test involves the patient tilting his or her head side to side while a real-time X-ray is taken of the C1–C2 movement. Here we’re looking for a significant overhang of the C1 over the C2 bone on lateral bending. Other tests that are helpful include an upper-cervical-specific MRI and a movement-based CT scan. PLEASE NOTE that an upper-cervical MRI is not the same as having had a routine cervical MRI. The latter does not image the CCJ area and uses a neck coil to get the image. An upper-cervical MRI includes the C0–C2 area and uses a head coil to get the image. So if all you’ve had is a routine cervical MRI, we may ask you to get an upper-cervical-specific study.

The upshot? My goal with today’s post is to make sure that patients understand that while we’re very happy that we now have a solution for many patients with CCJ instability, we also consider this new procedure new enough to require a strict inclusion and exclusion criteria. As we get more experience with the risks and benefits of the procedure, and after we have performed hundreds, we will likely feel more comfortable allowing more patients with just suspected CCJ instability to try this approach.

    *DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
    Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.

    comments

    Steve Trivoli says

    I believe I would be a candidate for this procedure. If proven so, what is the cost for this?
    Thanks

    replies

    Chris Centeno says

    Steve,
    Looking into the details for you...

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    Lynn trudeau says

    Hello if you hear of anything in stem cell my husband is in so much pain every day both shoulders have bad tares he also broke his back about 15 hrs ago and has back and neck pain we've been to so many Dr's and no one seems to have a real treatment the one Dr that is willing to try only gives him a 20 percent of it helping I'm so scared every day that his body will just shut done from the pain please if you know of any kind of help we have insurance 860 465 6825 thank you so much for your time

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    Chris Centeno says

    Lynn

    So sorry to hear all your husband is going through! Stem cell procedures are not yet covered by any type of Insurance, but we do treat shoulders, necks and backs with stem cells and platelets. It would be important to track down what caused what. If you have recent MRI's and would like us to see if your husband would be a Candidate for Regenexx procedures, please submit the Candidate form. The Advanced Stem Cell Support Formula supports your stem cells which are the repaitmen of your body and has ingredients wich help with pain and inflammation which many people have found helpful. You would need to check with his doctor for his approval and to make sure this would not interfere wth any of his medications. Please see: http://www.regenexx.com/regenexx-advanced-stem-cell-support-formula/ and http://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/

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    Allison Suddard says

    I've recently had this procedure (by Dr Centeno) and it is helping greatly. My guess is I will need to repeat it in the future due to the severity of my instability at the time of the first procedure. Would I be a candidate to participate in this study?

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    Chris Centeno says

    Allison,
    Great to her the procedure is helping! The study is not yet up and running so don't know whether a previous procedure will be an exclusion. I will be sure to make Dr. Centeno aware of your interest.

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    sandra says

    I had no prior injection untill now. Can I do this procedure in your office in colorado? If it fails, would it be possible to be a candidate for the alar/transverse/accessory legament procedure?

    replies

    Chris Centeno says

    Sandra,

    The CCJ Instability procedure is the procedure which treats the Alar, Transverse and Accessory Ligaments. While this procedure has been a game changer for the right patients, because it is so new and still experimental, it's crucial to make sure patients have gone through and failed the very specific list of more conservative procedures that would help. Similarly, there are a few things on the list whose positive results are indicators as well. Unfortunately, having had none of the more conservative injection based procedures in the criteria, you would not be a Candidate at this time, but might consider the more conservative procedures, as they might be all that's needed in your case! The list is in the Blog: http://www.regenexx.com/candidacy-for-ccj-instability-procedure/

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    Julie Bommarito says

    I have talked with Dr. Centeno and his team about getting the Alar/Transverse Ligament injections for CCJ Instability. Is there a study that may reduce the costs? I understand insurance does not cover the costs.
    If so, I would be greatly interested. My injections will take place in May of 2017.
    Many Thanks,
    Julie

    replies

    Chris Centeno says

    Julie,

    A study has been discussed but is not currently set up. We will advise you personally when more information becomes available.

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    Fox Thunderstorm says

    Hello, I have been suffering with upper cervical instability for over 2 years now. I do find temporary relief from a nucca chiropractor, but my neck seems to be getting more unstable as time goes on. I have just started prp treatment, so hopefully that will provide some help, however I am also wondering the total cost of getting this done? I live up in Canada so our healthcare is generally less specialized than in the states.

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    Chris Centeno says

    PRP injections of the upper neck with x-ray guidance is a good place to start. These should only be performed with either ultrasound or x-ray guidance and not blind. Realize that for some patients this works and is all that's needed. If this doesn't work, then the ligaments discussed here can't be reached with this type of posterior injection approach as this requires a specialized injection.

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    Fox Thunderstorm says

    Do you know how many injections and how long it will take to know if PRP will work for me? They are ultrasound guided, but like you said, they can't reach the main ligaments. I would like to begin the process of signing up for the regenexx procedure. I'm also wondering how long it takes after your stem cell injection to see a positive result?

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    Chris Centeno says

    Fox Thunderstorm,

    How long it would take to see results depends on what's injected as there is great variation in PRP, and there is great variation in the accuracy of injections. But if no improvement the next step would be facet joint injections which require fluoroscopy guidance. Because the CCJ Instability procedure has greater risk, the failure of a specific list of more conservative procedures is required for Candidacy. This criteria is outlined in the Blog. The only two locations that perform the CCJ Instability procedure are Colorado, and Brussels, Belgium.

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    James Waker says

    Hello Dr. Centeno

    I know I may not be candidate for the CCJ however I am interested in trying Upper cervical facet and posterior soft tissue treatment. I know the CCJ procedure requires multiple conservative treatments but how about upper cervical facet prp or stem cell? Unfortunately in my area no one that I know of is skilled enough to perform C0-C2 injections.

    replies

    Chris Centeno says

    James,
    Upper Cervical facet joint injections confirmed with Fluoroscopy and contrast are on the list of procedures which need to have failed to help long term. We do them in Colorado. Where are you located?

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    Laura says

    Interested in this. I have decades long chronic right side neck pain. With all the symptoms you mention. Ive had injections under fluoroscopy. Chiropractic helps short term. Multiple rounds of PT did not help. Its been a miserable life.

    What is the process to follow to find out if I qualify?

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    Chris Centeno says

    Laura,

    If you meet the all the inclusion and exclusion criteria stated, please call 303.495.4014.

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    Megan says

    Would this treatment work with craniocervical instability caused by general hypermobility, or even Elhers Danlos Syndrome, or does a potential candidate need to have otherwise healthy connective tissue?

    Also, are the pre-requisite injections for this procedure available at other Regenexx locations or only in Colorado?

    Finally, do you have guidance on where to find people to do the required imaging outside of Colorado?

    Thanks!

    replies

    Chris Centeno says

    Megan,
    Unfortunately any connective tiisue disorder is an exclusion for this procedure. Only a few sites perform the types of injections that are the pre-requisites for this procedure to rule out other possible causes. Please let us know if you wwould like assistance in setting up an evalution at one of those locations, as it may be a simpler issue.

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    Calley Lauren says

    Hello-
    I am in the Minneapolis/St. Paul area. I wonder if you know of any providers near me that offer the specific guided injections that need to be done (and failed) in order to meet the inclusion criteria for the CCJ Alar injections. I know of Dr. Baumgartner in St. Could who uses ultrasound but it appears this does not meet the criteria. I'm currently doing prolozone shots from a doctor who does blind injections, and I'm feeling no relief. I'd like to move onto another option, and want to choose wisely. Any provider lists that do the appropriate guided procedures would be so appreciated. Thank you.

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    Regenexx Team says

    Hi Calley,
    So important to be wise! There is no one we can recommend in the Minneapolis/St.Paul area. But will contact you with the best locations for the types of procedures you need.

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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