Atlantoaxial instability | Cervical Fusion or Prolotherapy PRP Stem Cell treatment options

Danielle R. Steilen, PA-CRoss Hauser, MD

In this article we will examine our published research findings and the latest in medical research concerning atlantoaxial instability and the myriad of symptoms and challenges it creates for patients.

Occipitoaxial fusion for atlantoaxial instability

When your C1-C2 cervical vertebrae are fused to limit atlantoaxial instability and related symptoms, the force and energy in your neck movements are going to be transferred to those vertebrae below the fusion. In many patients all this accomplishes is a transfer the problems of atlantoaxial instability to the lower cervical vertebrae.

The following research highlights these problems:

In a new study (July 2018) published in the Archives of orthopaedic and trauma surgery examined occipitoaxial fusion for atlantoaxial instability  in non-rheumatoid arthritis.

Study findings: More than 1/3rd patients had complications after occipitoaxial fusion for atlantoaxial instability

This type of surgery, with its high complication rate and similar procedures may not even be necessary. At Caring Medical we seek non-surgical regenerative medicine answers to solving the problems of Atlantoaxial instability without neck surgery. 

Cervical spine ligament weakness is why many cervical neck pain patients do not have successful surgery.

Doctors at University of Waterloo in Canada published research in the Spine Journal (4) where they were attempting to define a new clinical scoring system for patients with cervical neck instability. The scoring system would help identify the role of cervical ligaments in difficult to treat neck pain and instability.

This is what came out of this research:

Above is a sample of the handful of research from our office, German researchers and Canadian researchers who recognize the problems of cervical ligament damage in helping patients with atlantoaxial instability. This research is dwarfed by the amount of papers which deal with seeking out better ways to perform Atlantoaxial instability to limit complications, long hospital stays, and unsatisfactory outcomes.

Non-surgical options for atlantoaxial instability begins for an examination of the cervical ligaments

In a 2015 paper appearing in the Journal of Prolotherapy, we along with our co-writer Paul Fisher, wrote that cervical ligament injury should be more widely viewed as a key, if not THE key, to chronic neck pain. In our opinion, in many patients, cervical ligament injury is underlying pathophysiology (the cause of) atlantoaxial instability and the primary cause of cervical myelopathy (disease and dying vertebrae and cervical discs).(1)

This was a continuation in the series of published research Caring Medical Regenerative Medicine Clinics is producing on the problems of cervical instability including the 2014 article Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability lead by Danielle Steilen.(2)

In that research, our team suggested that the cervical capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and that they are a major source of chronic neck pain. The instability these injuries create often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome.

In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated cervical vertigo, dizziness, tinnitus, facial pain, arm pain, and migraine headaches.2


However, this hypothesis of ligaments being the underlying cause of chronic neck instability has little support in the medical community with respect to data correlating patient status with either repair-promoting treatments or documentation of regained stability. As we will see in the updated research below, cervical spine recommendations to treatment so often includes dangerous surgeries because the cervical neck problems are only seen by many health care providers as a disease of the vertebrae and discs, not the supporting structures including ligaments. New research is challenging this.

In June 2017, German researchers publishing in Zeitschrift für Orthopädie und Unfallchirurgie (Journal of Orthopedics and Trauma Surgery) also saw the connection of damaged cervical ligaments and chronic neck problems. Here is what they wrote:

The German team set out to investigate in human cadaver studies, fracture and displacement of the odontoid process and ruptures and tears of the transverse ligament. After examination and compilation of date, the researchers conclused:


Prolotherapy injections for Atlantoaxial instability

In 2015, Caring Medical and Rehabilitation Services published findings in the European Journal of Preventive Medicine investigating the role of Prolotherapy in the reduction of pain and symptoms associated with increased cervical intervertebral motion, structural deformity and irritation of nerve roots.

Twenty-one study participants were selected from patients seen for the primary complaint of neck pain. Following a series of Prolotherapy injections patient reported assessments were measured using questionnaire data, including range of motion (ROM), crunching, stiffness, pain level, numbness, and exercise ability, between 1 and 39 months post-treatment (average = 24 months).

We concluded that statistically significant reductions in pain and functionality, indicating the safety and viability of Prolotherapy for cervical spine instability.(6)

Axis - the most important bone in the cervical spine

If you have questions about Atlantoaxial instability, get help and information from Caring Medical

References for this article

1 Wu X, Qi Y, Tan M, Yi P, Yang F, Tang X, Hao Q. Incidence and risk factors for adjacent segment degeneration following occipitoaxial fusion for atlantoaxial instability in non-rheumatoid arthritis. Archives of orthopaedic and trauma surgery. 2018 Jul 1;138(7):921-7.  [Google Scholar]

1 Hauser R, Steilen-Matias D, Fisher P. Upper cervical instability of traumatic origin treated with dextrose prolotherapy: a case reportJournal of Prolotherapy. 2015;7:e932-e935.

2 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]

3 Meyer C, Bredow J, Heising E, Eysel P, Müller L, Stein G. Influence of Osseous and Ligamentous Injuries on the Stability of the Atlantoaxial Complex. Zeitschrift fur Orthopadie und Unfallchirurgie. 2017 Jun;155(3):318.  [Google Scholar]

4 Lasswell TL, Cronin DS, Medley JB, Rasoulinejad P. Incorporating ligament laxity in a finite element model for the upper cervical spine. The Spine Journal. 2017 Jun 30. [Google Scholar]

5 Hauser R, Steilen D, Gordin K The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study. European Journal of Preventive Medicine. Vol. 3, No. 4, 2015, pp. 85-102. doi: 10.11648/j.ejpm.20150304.11

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