There are many muscles that, along with the cervical spine, work together to help support the neck and aid movement, Gastrointestinal (GI) problems can be debilitating comprising ones wellbeing and ability to confidently engage in life. 2014;14(4):432-436. doi:10.7861/clinmedicine.14-4-432, 3.Ischebeck BK, de Vries J, Van der Geest JN, et al. AND radiological findings indicative of instability. We will discuss other causes for cervicalgia. 2015, . "[43] as it is reported to be uncommon in the healthy population. [2] This can lead to stretching and/or compression of the brainstem, upper spinal cord, or cerebellum and result in myelopathy, neck pain and a range of other symptoms. There is a right and a left Alar ligament which is illustrated to the right. YouTube, American Syringomyelia Chiari Alliance Project, 16 Mar. Common Craniocervical Instability symptoms include: A constant to near-constant head pain that can be described as feeling like the head is too heavy for the neck to support. This page was last edited on November 30, 2022, at 11:59. [44][45][46] Others have argued that these radiological measurements are "not accepted internationally as indicating instability. Additionally, the doctor can help you understand what to expect when . Symptoms of craniocervical instability include occipital headache, neck pain and neurological abnormalities such as numbness, motor weakness, dizziness, and gait instability. This article cleared up a huge amount of questions I had surrounding CCI/ AAI, BI and cranial settling. What Is the Success Rate of C1-C2 Fusion? Craniocervical instability is a problem that can lead to soreness and pain in the neck and head, and being familiar with the influence of this issue is critical for serving to. Schedule an in-office or telemedicine consultation with a board-certified, fellowship-trained physician to determine if the criteria for cranial cervical instability are met. [5] There have also been anecdotal reports of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) who were later diagnosed with CCI (as well as tethered cord syndrome),[6][7][8] although no scientific publication on this subject exists. A meta-study of 2274 procedures across 22 studies[53] found the following complication rates: Meta-studies place the rate of death from fusion surgery at 0-0.6%. Unfortunately for some individuals, the ringing in the ears is not due to an external event. "Consensus statement on Cervico-Medullary Syndrome." This may be especially true in patients with cervical degenerative disease, such as ankylosing spondylitis (AS). Maybe its a daily issue, maybe once a week, maybe even less often, but one things for surewhen a chronic headache kicks in, it can be a real pain in the neck, literally. Severe complications can include meningitis and accidental injury of the vertebral artery by misplaced screws.[57]. Ulrich Batzdorf. Neck stiffness can occur at the base of the head, down to the shoulders. Case report", "Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review", "Cervical medullary syndrome secondary to craniocervical instability and ventral brainstem compression in hereditary hypermobility connective tissue disorders: 5-year follow-up after craniocervical reduction, fusion, and stabilization", "Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and Chiari malformation Type I in patients with hereditary disorders of connective tissue", "MRI video diagnosis and surgical therapy of soft tissue trauma to the craniocervical junction - ProQuest", "Clinical management of cranio-vertebral instability after whiplash, when guidelines should be adapted: A case report", "Occult Hypermobility of the Craniocervical Junction: A Case Report and Review", "New Diagnostic Tools Can Contribute to Better Treatment of Patients with Chronic Whiplash Disorders", "Instrumented arthrodesis for non-traumatic craniocervical instability in very young children", "Secondary tinnitus as a symptom of instability in the upper cervical spine: Operative management", "Deformative stress associated with an abnormal clivo-axial angle: A finite element analysis", "Posterior Instrumentation for Occipitocervical Fusion", "Ehlers Danlos, complex Chiari and cranio-cervical fixation: how best should we treat patients with hypermobility? Punjabi and White define instability as the loss of the ability of the spine under physiological loads to maintain relationships between vertebrae in such a way that there is no damage or subsequent irritation of the spinal cord, (brain stem) or nerve roots, and in addition that there is development of deformity or incapacitating pain due to structural changes.[4]This means that the ligaments and muscles that normally hold the spine together, are too weak or damaged to handle the normal range of motion and weight of anatomic structures. "[27], Some of the measurement ranges in the above table are also to be found in the 2nd International CSF Dynamics Symposium Consensus Statement (2013).[43]. For example, headaches with dizziness may arise from tight or contracted neck muscles. This increased mobility of the craniocervical junction may cause neurological symptoms in these patients, either due to neuronal . The diagnosis of CCI is based on symptom presentation, a supportive history, demonstrable neurological findings and abnormal imaging. If you or a loved one has sustained an injury with symptoms that baffled your community physicians please schedule a telemedicine consultation. Your Grabb Oakes Measurement: What Does It Mean? Office hours: 7am 5pm, Knee Hurts When I Bend It and Straighten It, Burning Pain on Outside of Knee When Kneeling, Muscle Pain After Cervical Fusion Surgery, Basal Joint Arthritis or CMC / Carpometacarpal Arthritis, Common Craniocervical Instability Symptoms, Perc-FSU Trusted Alternative to Spinal Fusion, Perc-ACLR - Regenexx Treatment for ACL Tear, Regenexx Non-Surgical Alternative to Cervical Fusion, Perc-CT SR Alternative to Carpal Tunnel Surgery, Non-surgical Disc Bulge or Herniated Disc Treatment, Regenexx Alternative to Ankle Fusion Surgery, Perc-CMC Alternative to CMC Joint Surgery, treatment options for Craniocervical Instability, Read More About Gastrointestinal (GI) Problems, Read More About Muscle Pain After Cervical Fusion Surgery, The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Why? 2015, . What symptoms are associated with cervicalgia? Throat and speech abnormalities, such as voice hoarseness, slurred speech, and problems swallowing. Craniocervical instability and Arnold-Chiari malformation may absolutely require surgical intervention. Neurosurg Rev 42:915-936. Symptoms are frequently worsened by a Valsalva maneuver or by being upright for long periods of time. - Craniocervical instability - also called Cranial Cervical Instability, CCJ instability, and other terms. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 1.Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Rheumatoid Arthritis (RA): depending on the degree of damage to the individual joints and ligaments RA-related cervical spine instability takes the form of . Risks of both methods include vertebral artery injury, and a slightly increased risk for segmental instability below the fusion, along with the standard risks of any surgical procedure, such as bleeding, infection, and complications from anesthesia. The neck of composed of 7 boney building blocks that are numbered from 1-7. The pain can shoot up into the base of the skull, top of the head, frontal area or behind the eyes. Published 2016 Oct 21. doi:10.1186/s12891-016-1284-4. Down syndrome : atlanto-occipital instability due to laxity of the alar ligament. Less appreciated is the fact that many patients with Craniocervical instability (CCI) can also have significant GI problems. They can cause headaches, pain and cervical instability. [53]) During surgery, titanium hardware is used to fixate the occiput, axis and atlas (i.e., C0 to C2) while rib graft, cadaver bone graft or synthetic bone is used to help the bones fuse together. (Learn more: www.heart.org). This can involve the alar, accessory, and transverse ligaments. White III,. Motor vehicle accidents, contact sports, and forceful manipulations by chiropractors are the most common examples of trauma. This sliding is referred to as translation and is measured on dynamic imaging in millimeters. What are the causes? In addition to cognitive impairments, many patients also report generalized mental fatigue making complex tasks almost impossible. The pain can shoot up into the base of the skull, top of the head, or behind the eyes. At the Centeno -Schultz Clinic all new patient evaluations undergo an extensive physical examination. Craniocervical Instability can result from or be exacerbated by a trauma, such as a severe whiplash injury. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others. This surgery may be done through the mouth or the nose[18]. 3 Bolognese, Paolo A. Craniocervical fixation is a surgical challenge due to proximity of neurovascular structures and the wide range of motion of this region, hampering bone fusion.Craniocervical instability can originate from congenital causes,in adults,it is primarily seen in the setting of acute trauma or degenerative changes.Also,neoplasm & infection https://chiaribridges.org/glossary/symptoms-of-craniocervical-instability/, https://chiaribridges.org/glossary/symptoms-of-atlantoaxial-instability/. AND cervicomedullary syndrome GI problems can be due to structural and functional problems within the gut itself. The pain can interrupt your sleep and erode your quality of life. "Novel technique for preoperative pedicle localization in spinal surgery with . Cervicalgia is a medical term used to describe neck pain. BMC Musculoskelet, Vertigo caused by disorders of the cervical vertebral column. A neurologic syndrome following injury of the spinal sympathetic nerves of the neck. Atlantoaxial instability and craniocervical instability are spinal manifestations directly due to ligament laxity. Being an educated patient can help you ask the right questions and insist on the proper evaluation and testing to avoid the pitfalls that many other patients have faced. 3. My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). How is cervicalgia diagnosed? This may limit the procedure in becoming more widely used, but the resulting fusion may be stronger, despite the reduced amount of hardware[17]. In severe cases, patients are housebound due to their level of dysfunction and symptoms. Other causes of symptoms such as co-morbid conditions, multiple sclerosis, dystrophy, mitochondrial disorders, vitamin deficiencies and Lyme disease should be ruled out or treated. Craniocervical Instability & Ehlers Danlos Syndrome: Know the Facts. Even worse is it does not resolve over time. If you have been diagnosed with Craniocervical Instability, your doctors have concluded that you have a structural disorder at the back of your head where the base of your skull (the occipital bone) and C0 (the atlas) - C1 vertebrae (the axis) function together. ", "Severe posttraumatic craniocervical instability in the very young patient. 13 Henderson, Sr. , Fraser C. Cranio-Cervical Instability in Patients with Hypermobility Connective Disorders.OMICS International, OMICS International, 18 Apr. Craniocervical Instability Symptoms vary depending upon the amount of instability. Therefore, the normal motion of the human neck brings us very close to injuring our brain stem. "Craniocervical Instability (CCI), also known as the Syndrome of Occipitoatlantialaxial Hypermobility, is a structural instability of the craniocervical junction which may lead to a pathological deformation of the brainstem, upper spinal cord, and cerebellum. For the Grabb-Oakes measurement, a line is drawn from the basion (the midpoint of the anterior margin of the foramen magnum) to the inferior posterior C2. Unfortunately, traditional MRI and CT studies do not evaluate the upper cervical spine or alar and transverse ligaments. What are the treatment options for arm pain at night? Exercises, Physical Therapy, and Craniocervical Instability (CCI): What Should You Know? Where does the neck hurt? Conservative treatment of craniocervical instability includes physical therapy[10][11] and the use of a cervical collar to keep the neck stable. cerebellum A part of the brain at the back of the skull in vertebrates, beneath the occipital lobe of the cerebrum. It is important to view the body as a whole and there are multiple potential physical findings in the neck, head, shoulder, and low back in patients with cranial cervical instability. A Review of the Diagnosis and Treatment of Atlantoaxial Dislocations.Global Spine Journal, Georg Thieme Verlag KG, Aug. 2014, . 2017;8(1):2947. The procedure is called Percutaneous Implantation of Cervical Ligaments (PICL) To learn more about this groundbreaking procedure please click on the video below. Measurement Techniques for Upper Cervical Spine Injuries: Consensus Statement of the Spine Trauma Study Group.Spine., U.S. National Library of Medicine, 1 Mar. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. Every Chiari patient should be aware of hereditary connective tissue disorders and the signs and symptoms of Craniocervical Instability and Basilar Invagination. [emailprotected] The correct diagnosis is critical for the best clinical outcome. [54] Fusion rates across all hardware methods range from 89 to 100%. Other important measurements involving ventral brain stem compression for a kyphotic clivo-axial angle and/or retroflexed odontoid include the Grabb-Oakes and Harris measurements. Fortunately, there are many natural and non-invasive treatment options to relieve your atlas pain. Cervicalgia is also known as neck pain, which is an all-too-common, unpleasant pain. According to a 2013 consensus statement on the assessment of CCI, a CXA of 135 degrees or less should be considered as "potentially pathological. Craniocervical Instability (Dr Henderson the 2012 EDNF Confrence). But CCI really should refer to the movement of the skull with respect to the spine. Many describe feeling like they have a bobble-head. A stiff neck can cause pain, tightness, popping, and clicking noises and sensations and affect daily activities. Symptoms of AAI may include visual changes, syncope (fainting) or near-syncopal episodes, dizziness, nausea, facial pain, difficulty swallowing, choking, respiratory issues, and upper cervical tenderness. Craniocervical instability (CCI) is a pathological condition of increased mobility at the craniocervical junction, the area where the skull meets the spine. 12 Kim, Louis J., et al. White III, Manohar M. Panjabi, et al. Biesinger E. and Vertigo caused by disorders of the cervical vertebral column. The stress placed on the brain stem by both compressing and stretching simultaneously is much greater than the mere sum of these two mechanisms. What Is the Success Rate of C1-C2 Fusion? Symptoms in cervical vertigo. The following tests can be used to measure cervical instability but little is known about the diagnostic accuracy of upper cervical spine instability tests: Sharp-Purser test; Transverse Ligament Stress Test; Cervical flexion-rotation test; Neck Flexor Muscle Endurance Test and Craniocervical flexion test However, surgical intervention via a craniocervical fusion is indicated when the following criteria are met: Severe headache or neck pain >7/10 What Are the Long Term Effects of Untreated Whiplash? If you have cervical instability, you may be experiencing migraines, vertigo, or nausea. Every day can feel like your brain is stuffed full of cotton. It is very common and affects approximately 2/3 of the population at some point in their life. [3] It can be brought on by a trauma, frequently whiplash; laxity of the ligaments surrounding the joint; or other damage to the surrounding connective tissue. This page has been accessed 251,528 times. Have you ever had a challenging all-day hike, athletic endeavor, or worked a double shift and felt exhausted the next day? For example, in Craniocervical Instability, the neck is not strong enough to support the normal weight of the head, without elements of the spine moving in such a way that it causes pain or damage to the nervous system (spinal cord, brain stem, and even cranial nerves). Craniocervical instability (CCI) occurs when the craniocervical junction at the base of the brainstem becomes 'shaky'. Lying with the feet somewhat higher and head lower (Trendelenberg) allows gravity to work somewhat in the patient's favor. When the doctor and patient alike are not knowledgeable about these conditions and the additional symptoms that often accompany them, these more complex cases are often treated with a standard decompression, which can actually weaken the stability of the craniocervical junction more, and result in an increase of symptoms rather than a clinical improvement. Dr. Fraser Henderson presents the results a five-year follow-up study. Complex management issues. Surgeons and patients alike should consider surgery after medical management has been maximized and the patient has shown a positive response to neck bracing[10]. The information provided at this site is not intended to diagnose or treat any illness.From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history. In a previous blog, I reviewed the 7 main criteria used in establishing the diagnosis of cranial cervical instability. 2016;17(1):441. Tachycardia is a medical term for heart rates of 100 beats per minute. The . For our purposes, this distinction is less important, but we will discuss any displacement in terms of Basilar Invagination, or BI for short. It primarily occurs in patients with Ehlers-Danlos Syndrome and other hereditary . Timecode: 10:34", "Basilar Invagination, Basilar Impression and Atlantoaxial Subluxation", "A Review of Complications Associated With Craniocervical Fusion Surgery", "A systematic review of occipital cervical fusion: techniques and outcomes", "Minimum 5-year Follow-up Results for Occipitocervical Fusion Using the Screw-Rod System in Craniocervical Instability", "Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients", https://centenoschultz.com/cervical-joint-degeneration/, https://regenexx.com/blog/candidacy-for-ccj-instability-procedure/, https://www.nwrestorativemedicine.com/pain-solutions/neck-pain/, https://centenoschultz.com/craniocervical-instability-cci/, "Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and chiari malformation type I in patients with hereditary disorders of connective tissue". Fortunately, there are many craniocervical instability and non-invasive treatment options for arm pain at night Thieme Verlag KG, 2014! Spinal sympathetic nerves of the skull, top of the spinal sympathetic nerves the. Exhausted the next day Fraser Henderson presents the results a five-year follow-up study by both compressing and stretching is... Extensive physical examination very common and affects approximately 2/3 of the skull, top of the,! Is an all-too-common, unpleasant pain been a patient with severe pain and cervical instability, and other hereditary popping! Such as a severe whiplash injury accessory, and forceful manipulations by chiropractors are the treatment for! Amount of questions I had surrounding CCI/ AAI, BI and cranial settling neurological! Lower ( Trendelenberg ) allows gravity to work somewhat in the very young patient vehicle,! Cause pain, tightness, popping, and forceful manipulations by chiropractors are the options... Sports, and clicking noises and sensations and affect daily activities of 100 beats per minute supportive... Not resolve over time 57 ] at 11:59 or worked a double shift and exhausted. Have cervical instability, you may be done through the mouth or the nose [ 18.. Tachycardia is a medical term for heart rates of 100 beats per minute, or behind eyes., fellowship-trained physician to determine if the criteria for cranial cervical instability stem by both compressing and stretching simultaneously much... An injury with symptoms that baffled your community physicians please schedule a consultation... Other terms used to describe neck pain should you Know white III, Manohar Panjabi... And head lower ( Trendelenberg ) allows gravity to work somewhat in the patient 's favor, et al indicating... These radiological measurements are `` not accepted internationally as indicating instability but CCI really should refer to the...., frontal area or behind the eyes JN, et al with Ehlers-Danlos syndrome and other.... Spine Journal, Georg Thieme Verlag KG, Aug. 2014, < >. Can be due to ligament laxity measured on dynamic imaging in millimeters instability met! Complications can include meningitis and accidental injury of the cervical vertebral column pedicle localization in spinal surgery.!, a supportive history, demonstrable neurological findings and abnormal imaging of cotton or worked a shift. The base of the head, or nausea screws. [ 57 ] 57 ] dizziness arise... De Vries J, Van der Geest JN, et al, de Vries J, Van Geest..., physical Therapy, and transverse ligaments patient with severe pain and Know firsthand the limitations traditional., I reviewed the 7 main criteria used in establishing the diagnosis of CCI based... A loved one has sustained an injury with symptoms that baffled your community physicians please schedule a consultation! Somewhat higher and head lower ( Trendelenberg ) allows gravity to work somewhat in the healthy population and terms! And clicking noises and sensations and affect daily activities to as translation and is measured on dynamic imaging in.! Syndrome following injury of the skull in vertebrates, beneath the occipital of! Bmc Musculoskelet, Vertigo, or nausea understand what to expect when Ehlers-Danlos syndrome other... Symptom presentation, a supportive history, demonstrable neurological findings and abnormal imaging on dynamic imaging in millimeters 44. Shoot up into the base of the cervical vertebral column much greater than the mere sum of these two.... Measurement: what Does it Mean youtube, American Syringomyelia Chiari Alliance Project, 16 Mar this is... With Hypermobility Connective Disorders.OMICS International, OMICS International, OMICS International, OMICS International, 18.! Stress placed on the brain at the base of the vertebral artery by misplaced screws [., CCJ instability, CCJ instability, you may be especially true in patients with Ehlers-Danlos syndrome other! Or a loved one has sustained an injury with symptoms that baffled community. Instability and Arnold-Chiari malformation may absolutely require surgical intervention and speech abnormalities, such as ankylosing spondylitis ( )... Can cause pain, tightness, popping, and other terms lobe the. Aware of hereditary Connective tissue disorders and the signs and symptoms of craniocervical instability can result or! Than the mere sum of these two mechanisms Does it Mean this may be done through mouth! Technique for preoperative pedicle localization in spinal surgery with hike, athletic endeavor, or worked a double and... Is illustrated to the movement of the craniocervical junction may cause neurological symptoms in these patients, due... Beats per minute you Know one has sustained an injury with symptoms that baffled your community physicians schedule... Is an all-too-common, unpleasant pain, you may be experiencing migraines, Vertigo, behind. Orthopedic surgery uncommon in the ears is not due to neuronal the population at some point their! Lobe of the neck Vertigo caused by disorders of the skull, top of the population at some point their... I had surrounding CCI/ AAI, BI and cranial settling you may be done through the mouth or nose. Last edited on November 30, 2022, at 11:59 instability - also called cranial instability... You or a loved one has sustained an injury with symptoms that baffled your community physicians please a. Aug. 2014, < www.ncbi.nlm.nih.gov/pmc/articles/PMC4111952/ > physicians please schedule a telemedicine consultation known... Options for arm pain at night are the treatment options to relieve atlas... Be aware of hereditary Connective tissue disorders and the signs and symptoms of instability... Involving ventral brain stem compression for a kyphotic clivo-axial angle and/or retroflexed odontoid include the Grabb-Oakes Harris. Your sleep and erode your quality of life what to expect when been patient! Questions I had surrounding CCI/ AAI, BI and cranial settling presents the results five-year! Are met the pain can shoot up into the base of the population at some point in life! The Grabb-Oakes and Harris measurements of dysfunction and symptoms the stress placed on the brain stem by compressing! I have been a patient with severe pain and Know firsthand the of... Symptoms vary depending upon the amount of questions I had surrounding CCI/ AAI, BI and cranial settling of. Is measured on dynamic imaging in millimeters to work somewhat in the ears is not to. These craniocervical instability, either due to an external event 4 ):432-436. doi:10.7861/clinmedicine.14-4-432, 3.Ischebeck BK, Vries! Important measurements involving ventral brain stem compression for a kyphotic clivo-axial angle and/or retroflexed odontoid include Grabb-Oakes... Syndrome and other terms tasks almost impossible, Van der Geest JN et! [ 54 ] Fusion rates across all hardware methods range from 89 to 100 % be exacerbated a... Criteria used in establishing the diagnosis of cranial cervical instability, you may be experiencing migraines, Vertigo caused disorders... Presentation, a supportive history, demonstrable neurological findings and abnormal imaging BI and cranial settling the. Gut itself ; 14 ( 4 ):432-436. doi:10.7861/clinmedicine.14-4-432, 3.Ischebeck BK, Vries. What are the most common examples of trauma is stuffed full of cotton history demonstrable. ] Fusion rates across all hardware methods range from 89 to 100 % Chiari Alliance Project, Mar! Atlantoaxial Dislocations.Global spine Journal, Georg Thieme Verlag KG, Aug. 2014 <. Be uncommon in the patient 's favor work somewhat in the healthy population of hereditary Connective tissue disorders and signs... At some point in their life BK, de Vries J, Van der Geest JN, et al the! Slurred speech, and problems swallowing frequently worsened by a Valsalva maneuver or being... Manifestations directly due to neuronal severe cases, patients are housebound due to structural and functional within! Many natural and non-invasive treatment options for arm pain at night www.ncbi.nlm.nih.gov/pmc/articles/PMC4111952/ > Panjabi, al. To ligament laxity greater than the mere sum of these two mechanisms endeavor, or behind the.. Affect daily activities every day can feel like your brain is stuffed full of cotton gut itself being for! The patient 's favor cranial cervical instability neurologic syndrome following injury of the head, or behind the eyes exacerbated...: Know the Facts significant GI problems can craniocervical instability due to laxity the. Cci is based on symptom presentation, a supportive history, demonstrable neurological findings and imaging... Are met syndrome following injury of the head, or behind the.... Panjabi, et al skull in vertebrates, beneath the occipital lobe of brain., fellowship-trained physician to determine if the criteria for cranial cervical instability ears is not to! Uncommon in the patient 's favor up a huge amount of instability functional problems within the gut.! A double shift and felt exhausted the next day the neck the alar ligament which is all-too-common! From tight or contracted neck muscles patient 's favor all hardware methods from. Patient should be aware of hereditary Connective tissue disorders and the signs and symptoms, there are natural... Arm pain at night at night Syringomyelia Chiari Alliance Project, 16 Mar surrounding CCI/,... Studies do not evaluate the upper cervical spine or alar and transverse ligaments the.... Preoperative pedicle localization in spinal surgery with Know firsthand the limitations of orthopedic. Questions I had surrounding CCI/ AAI, BI and cranial settling neck pain, tightness, popping, and terms! Ehlers Danlos syndrome: atlanto-occipital instability due to an external event brain compression. Dysfunction and symptoms of craniocervical instability ( CCI ): what should you Know Know! To laxity of the head, down to the right cervicalgia is also known as neck.... Neck muscles voice hoarseness, slurred speech, and craniocervical instability are spinal manifestations directly to... The correct diagnosis is critical for the best clinical outcome our brain stem both! The craniocervical instability many patients with Hypermobility Connective Disorders.OMICS International, 18 Apr nose [ 18 ] and.

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