Imaging and Consultation Options for Diagnosing Craniocervical and Atlantoaxial Instability

 

When diagnosing complex spinal conditions like Craniocervical Instability (CCI), Atlantoaxial Instability (AAI), Tethered Cord, or Chiari Malformation, obtaining precise and high-quality imaging is critical. At DrGilete.com, we offer multiple pathways tailored to the patient’s health status and geographical location—ranging from comprehensive in-person evaluations in Barcelona to remote consultations with imaging reviewed via telemedicine. Below we outline each available option in detail.

 

1. Scans and Consultation in Barcelona

We now offer the option to come directly to Barcelona to complete the upright imaging and a consultation and evaluation from Dr. Gilete all in one visit. This package has the benefit of convenience and cost saving as the price for all the imaging and consultation is half what the price would be individually.

The upright imaging in Barcelona is a new technology that uses a cone-beam CT scanner (CBCT), requiring the patient to hold positions for a much shorter period of time compared to an upright MRI. The CBCT scan does use radiation, but the radiation exposure is much lower than a traditional CT scan. The five positions needed for diagnosis roughly equal the radiation from one standard CT scan. The imaging from the CBCT scan is excellent for diagnosing instability as it exposes bone structure instead of soft tissue.

 

What is offered?

Package A:

  • Upright cervical CBCT in flexion, extension, neutral, to assess Craniocervical Instability
  • Cervical CBCT in rotation left, right, neutral, to assess Atlantoaxial Instability
 

Package B:

  • Upright cervical CBCT in flexion, extension, neutral, to assess Craniocervical Instability
  • Cervical CBCT in rotation left, right, neutral, to assess Atlantoaxial Instability
  • MRI arterial/vein study of the head and neck, investigates stenosis or compression of the vascular structure of the brain and neck. Performed without contrast fluid.
 

Package C:

  • Upright cervical CBCT in flexion, extension, neutral, to assess Craniocervical Instability
  • Cervical CBCT in rotation left, right, neutral, to assess Atlantoaxial Instability
  • Prone and supine lumbar MRI to rule out Tethered Cord
 

Package D:

  • Upright cervical CBCT in flexion, extension, neutral, to assess Craniocervical Instability
  • Cervical CBCT in rotation left, right, neutral, to assess Atlantoaxial Instability
  • Arterial/vein study of the head and neck, investigates stenosis or compression of the vascular structure of the brain and neck. Performed without contrast fluid.
  • Brain MRI to rule out Chiari
  • Cervical MRI to rule out herniation or cervical malformation
 

Package E:

  • Upright cervical CBCT in flexion, extension, neutral, to assess Craniocervical Instability
  • Cervical CBCT in rotation left, right, neutral, to assess Atlantoaxial Instability
  • Arterial/vein study of the head and neck, investigates stenosis or compression of the vascular structure of the brain and neck. Performed without contrast fluid.
  • Brain MRI to rule out Chiari
  • Cervical MRI to rule out herniation or cervical malformation
  • Prone and supine lumbar MRI to rule out Tethered Cord
 

A medical report from Dr. Gilete can be added to any of the imaging packages above. The medical report is a summary of your symptomology, observations from the physical exam, measurements, diagnosis, and recommended treatment.

 

How can I prepare?

Someone from our team will assist you during your scans, but it is required that any patient travelling to Barcelona come accompanied by a supportive friend or family member.

  • Please come dressed comfortably, with no jewelry.
  • The CBCT series of scans takes around 45 minutes.
  • If you choose to do one of the more extensive packages, be aware it can take at least three to four hours to complete.
  • Notify us if you are taller than 185 cm (6ft), significantly overweight (BMI 30+), or have very broad shoulders.
 

Once your visit is scheduled, we will send you a set of comprehensive questionnaires to gather your personal information, clinical history, and symptomology. These must be completed at least one week before your imaging appointment to allow time for Dr. Gilete to review your case. After your scans are reviewed, you will meet with Dr. Gilete to go over findings, undergo a neurological exam, and discuss treatment options.

 

2. Submit Imaging for Review and In-Person Consultation in Barcelona

This option allows you to submit scans done at a nearby upright imaging center for Dr. Gilete’s review, followed by a face-to-face consultation in Barcelona.

 

What imaging should be included?

  • Upright MRI of the cranio-cervical junction and cervical spine in:
    • Maximum flexion (sagittal cuts)
    • Maximum extension (sagittal cuts)
    • Maximum rotation, both sides (axial cuts)
    • Neutral (sagittal and axial cuts)
 

T2 imaging is preferred. Positioning should not provoke serious symptoms. The odontoid peg and surrounding region should be visible in all imaging as well as the basion. Neutral imaging should show hindbrain. All submitted imaging must be in DICOM format.

 

Additional imaging that may also be helpful:

  • Cervical lateral cineradiology or DMX (flexion, extension, lateral bending)
  • Cervical lateral x-ray in flexion, extension, neutral
  • Full spine x-ray in anteroposterior and lateral
  • Any additional spine or brain MRIs or CTs less than two years old
 

Next Steps

Once imaging is uploaded, you will receive a proposed date for your consultation in Barcelona. You may also request a report from the visit. Prior to the consultation, a set of comprehensive questionnaires will be sent to gather all relevant medical history and symptoms.

 

3. Submit Imaging for Remote Consultation via Zoom

For those unable to travel, this remote option allows you to submit your scans for a virtual consultation with Dr. Gilete.

 

What imaging should be included?

  • Upright MRI of the occipital-cervical junction and cervical spine in:
    • Maximum flexion (sagittal cuts)
    • Maximum extension (sagittal cuts)
    • Maximum rotation, both sides (axial cuts)
    • Neutral (sagittal and axial cuts)
 

Note: Most upright clinics in North America do not offer rotational imaging. In such cases, CT scans in left, right, and neutral positions (C0-C3 axial cuts with 3D reconstruction) are necessary to investigate AAI, but be aware this incurs high radiation exposure.

 

Additional imaging that may also be helpful:

  • Cervical lateral cineradiology or DMX (flexion, extension, lateral bending)
  • Cervical lateral x-ray in flexion, extension, neutral
  • Full spine x-ray in anteroposterior and lateral
  • Any additional spine or brain MRIs or CTs less than two years old
 

Next Steps

After submitting your imaging in DICOM format, you’ll be sent a Zoom consultation date and payment link. Before the appointment, you’ll be asked to complete a set of comprehensive questionnaires to gather clinical information.

 

4. Alternatives to Upright Imaging

Upright imaging is preferable for accurate diagnosis, as weight-bearing positions reveal instability more clearly. However, supine imaging is an alternative when upright imaging is not available in your region or not possible due to the patient’s condition.

 

Required Imaging

Supine MRI of the occipital-cervical junction and cervical spine in:

  • Maximum flexion (sagittal cuts)
  • Maximum extension (sagittal cuts)
  • Neutral (sagittal and axial cuts)

AND

 

CT scans with 3D reconstruction of the occipital-cervical junction and cervical spine (down to C3) in:

  • Maximum rotation, both sides
  • Neutral
 

Note: Positioning for supine imaging is complex and requires experienced technicians. Pillows or foam supports are used for achieving flexion and extension positions. CT scans incur significant radiation exposure.

 

Next Steps

Once scans are complete, upload them using the provided form. A Zoom or face-to-face consultation will be scheduled. Prior to this, you will receive questionnaires for clinical history and symptomology. A visit report is optional.

 

5. Upright Clinics

While we prefer patients to visit Barcelona for optimal imaging and consultation quality, we understand this may not always be feasible. Below is a courtesy list of upright clinics equipped with FONAR upright MRI machines. This list does not imply endorsement, and quality cannot be guaranteed.

 

Europe

  • Medserena London
  • Medserena Manchester
  • Upright MRI Köln
  • Upright MRI Hannover
  • Upright MRI München
  • Upright MRI Frankfurt
  • Upright MRI Hamburg
 

Asia/Pacific

  • American Upright MRI Dubai
  • Upright Multipositional MRI Sydney
 

North America

(Please note: Clinics in North America do not offer rotational imaging)

  • CDI Minneapolis
  • CDI Milwaulkee
  • CDI St Louis
  • CDI Seattle-Tacoma
  • SUMA MRI Minneapolis
  • Open Upright MRI Birmingham
  • Clermont Radiology Orlando
  • Rose Radiology St Petersburg
  • ExpertMRI San Diego
  • ExpertMRI Bakersfield
  • ExpertMRI Beverly Hills
  • ExpertMRI Riverside
  • American Dynamic Imaging San Antonio
  • American Dynamic Imaging Dallas-Ft Worth
  • Upright MRI Deerfield
  • Dynamic Medical Imaging Newark
  • Upright MRI Fort Wayne
  • MRI of America Colorado
 
 

Frequently Asked Questions (FAQs)

 

What is the best imaging option for diagnosing CCI or AAI?

The best imaging option is upright imaging, particularly using CBCT in multiple positions. It allows for accurate assessment of instability under weight-bearing conditions.

Can I use imaging from another clinic for a consultation?

Yes. You may upload existing upright imaging in DICOM format for review, provided it includes all necessary views. This applies for both in-person and remote consultations.

Is upright MRI the same as open MRI?

No. An open MRI is not equivalent to an upright MRI. Only upright MRIs (typically FONAR machines) provide weight-bearing views crucial for accurate diagnosis.

What if I cannot undergo upright imaging?

If you’re bedbound or unable to access upright imaging, supine MRI and CT scans are alternatives, though they are less optimal. Specific positioning is required for proper assessment.

How long does the imaging process take in Barcelona?

Basic CBCT imaging takes about 45 minutes. More comprehensive packages can take three to four hours to complete.

Can I receive a written report from Dr. Gilete?

Yes. A medical report summarizing diagnosis, findings, and treatment recommendations can be requested with any imaging package.

 

Conclusion

DrGilete.com provides multiple tailored options for patients worldwide needing diagnosis and treatment planning for Craniocervical Instability, Atlantoaxial Instability, Tethered Cord, and Chiari Malformation. Whether you’re able to travel to Barcelona or require a remote approach, our team ensures thorough, expert-level review and compassionate care. From advanced CBCT imaging to personalized consultation and reporting, every step is designed with your health and convenience in mind. 

For those ready to begin the journey toward clarity and improved well-being, we invite you to request an evaluation and schedule your next step with us.

Dr Gilete seated at a desk using a computer mouse while reviewing a three-dimensional CT rendering of a skull and cervical spine on a desktop monitor
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