Do you experience severe, debilitating symptoms that potentially fluctuate depending on the position you are in and do your regular supine scans keep coming back normal? For people living with CCI (Craniocervical Instability) or AAI (Atlantoaxial Instability), this is a frustrating, everyday reality.
Traditional MRIs require you to lie completely flat. But when you lie down, gravity stops pushing your head down onto your neck. The stretched ligaments are no longer required to support your neck in an upright position, and your scan looks “perfectly normal”.
However we are not supposed to spend the majority of our life lying down, we are supposed to function and live our life in an upright position. So why do we not perform imaging that looks at how the spine functions in the position that we are actually supposed to function in? Namely: upright.
Why upright imaging is a game-changer
When you are scanned sitting or standing up, a couple of major things happen that make a diagnosis possible:
- Gravity is doing its job: The weight of your head actually presses down on your cervical spine. If your ligaments are too lax, this natural pressure can cause the joints to shift, allowing the machine to capture the potential instability exactly as it happens in daily life.
- Dynamic views (flexion, extension, tilt and rotation): Instead of keeping your neck perfectly still, upright imaging allows you to look down (flexion), look up (extension), tilt your head or turn your head (rotation) during the scan, though sometimes, rotation laying down is also an equivalent way to detect atlantoaxial instabilities..
How it helps to diagnose CCI and AAI
By capturing images while your neck is moving under the weight of your head, specialists can look for very specific, subtle measurements:
- For CCI (Craniocervical Instability): Neutral, flexion and extension scans are needed in order to see if there is instability at the level of C0-C1.
- For AAI (Atlantoaxial Instability): Tilt and rotational scans to both sides are needed to look if there is instability at the level of C1-C2.
Upright MRI as an example of upright imaging 📸
One way to potentially diagnose CCI and AAI is by evaluating an upright MRI (*always in combination with evaluating the clinical picture of the patient). However there are several factors that can limit the usefulness of the upright MRI.
- Upright MRI-scans are difficult to find, often requiring a long travel in order to be able to undergo the scan.
- Sometimes the quality of the imaging is not sufficient, meaning no formal and official diagnosis can be made from the images, as the bony parts are sometime not well seen.
- Not all upright MRI-centers offer rotational imaging besides neutral, flexion and extension images.
- An upright MRI requires you to hold the head positions for a very long time, which can be very debilitating or even impossible for some patients.
- It is very useful to evaluate soft tissues but not the primary choice to evaluate bone structure.
Using an upright Cone Beam CT-scan (uCBCT) as alternative to the uMRI 🩺
In International Center of Excellence for EDS & CCI Surgery in Barcelona we do not work with an uMRI machine. Instead we work with an upright Cone Beam CT-scan (uCBCT) scan for diagnostic purposes of CCI and AAI. Why do we choose the uCBCT scan over the uMRI?
- The uCBCT scan allows you to hold the upright positions for a much shorter time, making it significantly easier for the patient to undergo the imaging process.
- Holding positions for a shorter period of time avoids blurry images due to movement artifacts.
- While the uMRI is very good for looking at soft tissue, the uCBCT scan is superior for looking very precisely at your bones, allowing us to measure the exact millimeters of joint mobility and structural alignment.
- The sharp edges caught by the uCBCT scan allow for more accurate measurements, reducing the margin of error.
- The amount of radiation that you’re exposed to when undergoing the uCBCT scan is much lower compared to the amount of radiation from a regular CT-scan.
If you’ve been battling unexplained symptoms and suspect they might be related to your (cervical) spine, but your standard MRIs keep coming back clear, dynamic imaging might be the missing piece of the puzzle.
A proper diagnostic evaluation and validation matters. Don’t let a supine scan tell you that your symptoms aren’t real or impossibly connected to your spine.
#CCI #AAI #UprightImaging #UprightMRI #uCBCT #UprightCBCT #ChronicIllness #EhlersDanlosSyndrome #Hypermobility #CervicalInstability #Craniocervicalinstability #Atlantoaxialinstability #InvisibleIllness
