Are You a Candidate for Our Novel CCJ Instability Procedure?

POSTED ON 01/06/2017 IN Neck/Cervical BY Chris Centeno

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.

Alar Ligament Treatment Dr Centeno Lecture at AAOM 2016

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.