This video and explanatory notes focus on the problems of cervical myelopathy, cervical degenerative disc disease, and cervicovagopathy as a condition of Cervical Dysstructure or a broken neck structure.
What does the term Cervical Dysstructure mean?
To be clear, broken neck structure means that the cervical spine is unstable and no longer allows a pain-free range of motion. Further, the unstable cervical spine can then be implicated in a myriad of mysterious and unrelenting symptoms that the person is suffering from.
More simply and to put this idea into the context of a person’s health issues, Cervical Dysstructure or a broken neck structure means something more like this. This is the story of a person who contacted us:
I had a bad accident
I had a bad accident. It resulted in a significant whiplash injury. The impact of the accident forced my head back and caused a reverse lordosis in my cervical spine along with chronic TMJ, headaches, lightheadedness, anxiety, and high blood pressure problems. I can’t seem to find a doctor who can help relieve the symptoms.
An old whiplash injury causes new symptoms 25 years later
In this story, a patient describes having pain and onset of symptoms 25 years after a whiplash injury and a problem traced to “straight neck” of a “military neck.”
I had many symptoms start suddenly. Heart palpitations are being treated with beta-blockers, tinnitus, vertigo, neck and back pain, sleeping disorders, eating disorders, my head gets stuck when I turn to the left.
Neck Surgeon said I should see a psychiatrist or brain surgeon
I started having the gradual onset of multiple symptoms. This included extreme weakness, tingling, ear and head fullness, blurred vision, jaw locking, occasional tremors. Feeling of being drunk, vision is weak.
The first hospital diagnosed cervical stenosis, foraminal narrowing, spondylolisthesis C3-C5, and lordosis. The worst area was C5-C7. One month after the culmination of onset of symptoms I had an anterior discectomy and fusion done. Since surgery, symptoms in the head have continued. . . Neck Surgeon said I should see a psychiatrist or brain surgeon.
Cervical Dysstructure or a broken neck structure means
What do these people appear to have in common?
The cervical spine should have lordotic curvature, it should be shaped like a C. The C shape acts as a shock keeps stress forces on the cervical spine at a minimum. When you have a cervical spine ligament injury, the ligaments cannot hold the C shape. The neck can progress to a Military curve, which is straight up and down. Eventually, the natural curve of the neck distorts and twists, first into the reverse kyphotic curve, then into a letter “S” shape.
What is cervical dysstructure (“Broken neck” structure) and cervicovagopahy? How do we treat it?
Ross Hauser, MD explains the term he coined: Cervical Dysstructure, how it may be diagnosed, the symptoms and conditions associated with it, and why health depends on maintaining a proper neck curve and posture.
What are we seeing in this image?
The progression of degenerative or impact injury will eventually distort the cervical spine and cause some people many neurologic-like, cardiovascular-like, and psychological-like issues.
Cervical dysstructure of the neck means that the natural structure of the cervical spine is broken.
This natural structure has been broken by cervical instability and degenerative wear and tear causing a situation of cervical osteoarthritis and loss of cervical spine curvature.
Understanding the broken neck structure problem can help you understand why you have problems such as cervical spinal stenosis, cervical spine arthritis, cervical degenerative disc disease, and bulging and herniated discs. Understanding the broken neck structure problem may also explain why you have the many symptoms described here.
What are we seeing in this image?
This slide is at 1:10 of the video. At this point in the video, Dr. Hauser is demonstrating functional problems in the cervical spine caused by cervical instability of broken neck structure. This slide has a diagnosis on the right and a possible treatment recommendation on the left. These treatments will be described briefly here and then expanded on further in this video summary and notes.
Capsular facet ligament injury
In our research published in The Open Orthopaedics Journal, (1) we describe the capsular ligaments as the main stabilizing structures of the facet joints in the cervical spine, and injury, laxity, or weakness in these ligaments have been implicated as a major source of chronic neck pain. Many diagnoses including disc herniation, cervical spondylosis, whiplash injury, and whiplash-associated disorder, post-concussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome can be linked to capsular facet ligament injury.
Prolotherapy. To the right is a treatment to restore ligament strength. This is Prolotherapy. Prolotherapy is the use of simple dextrose injections to reawaken the healing immune response. This is explained further below.
Vertebral rotation (subluxation) is as it sounds the cervical vertebrae are now twisting out of place or are in a condition of subluxation.
After an examination, we may suggest Dynamic ortho neurological correction which is a specific kind of chiropractic adjustment that we do at the Hauser Neck Center. In Dynamic ortho neurological correction, we watch the movement of the bones under the Digital Motion X-Ray imaging and then adjust to try to correct the bone’s position and get them back into a better alignment.
Chiropractic may be a good place to start, especially if you have dull pain.
The adjacent vertebra moves forward (anterior). Commonly cervical spondylolisthesis. Cervical Spondylosis is an umbrella term used to describe degenerative changes in the cervical spine when there is no clear answer as to why you suffer from any one of a long list of symptoms already mentioned above.
Cervical curve collapse
Cervical curve correction. Caring Cervical Realignment Therapy (CCRT) or what we often call “Curve Correction” for short is a treatment I (Ross Hauser, MD) developed after decades of treating patients with neck disorders. CCRT combines individualized protocols to objectively document spinal instability, strengthen weakened ligament tissue that connects the vertebrae, and re-establish normal biomechanics and encourage restoration of lordosis. Please see our article Caring Cervical Realignment Therapy – Curve Correction.
What are we seeing in this image? A visual description of how compression in the cervical spine can lead to problems of cervical spine neurology
This image is at 1:40 of the video.
Here we see that the carotid sheath and all its vital structures lay on top of the C1 Atlas. When the Atlas or C1 starts “wandering” out of place it takes the carotid sheath with it, stretching the arteries, veins, and the glossopharyngeal nerve and vagus nerve or compressing the arteries, veins, and glossopharyngeal nerve, and vagus nerve. When there is compression there can be symptomology. The person is now suffering from “neurologic-like” symptoms.
Changes in the cervical curve
At 2:00 of the video presentation, Dr. Hauser describes changes in the cervical curve that can cause many of the symptoms that we see in our patients.
In this image, there is a left-to-right comparison being illustrated in two patients’ neck curves. On the left is a normal cervical curve. The focus is on the correct position of the vagus nerve. The vagus nerve will be discussed below. In the abnormal curve demonstrated on the right, the vagus nerve is being stretched and compressed. It is this stretching and compression that can lead to the neurological-like, cardiovascular-like, psychological-like symptoms that many of our patients suffer from.
When you have cervical dysstructure, you can have symptoms of neck pain, headaches, dizziness, tinnitus, ringing in the ears, vertigo, swallowing difficulty, speech difficulty, digestive problems, tachycardia, POTS, mast cell activation, and others. Our treatment philosophy is not to treat all these maladies as separate challenges but rather look for the underlying cause of all of them in the cervical spine that has a broken neck structure.
Cervical dysstructure is a broken neck structure it starts with the breakdown of the cervical capsular ligaments that hold the facet joints in place. Once the ligaments become weakened it allows the bones of the neck to start rotating and wandering out of place. The person develops vertebral rotations or vertebral subluxation and these problems can cause the person the challenges they face.
In this scenario, sometimes the person can find symptomatic relief with chiropractic. Even a minor adjustment to the spine can sometimes have a dramatic effect. In some people, chiropractic may be a good place to start in the determination of their situation, especially in people with dull pain and minus the neurologic-like symptoms.
If the instability progresses and joint instability is a progressive disorder, once you have one ligament injury in the neck the destructive forces go to the next joint in the neck, straining those cervical ligaments, this is why symptoms programs because cervical instability is a progressive disorder. Eventually, the adjacent vertebrae move forward.
This image is at 4:25 of the video:
What are we seeing in this image? The vertebrae will eventually fall like dominos because of cervical instability is a progressive disorder moving up and down the cervical spine collapsing the cervical spine like a bunch of dominos.
What are we seeing in this image? Cervical curve collapse of cervical dysstructure under x-ray
A description of the 5 major detrimental effects of Cervical Kyphosis (Dysstructure).
Weight of head in front of cervical curve
Stretching of the posterior ligament complex
Increased for of atlantoaxial (C1-C2) joint.
Lengthening (stretching) of neck neuro vasculature including the vagus nerve.
Increased tension on the brainstem.
The red line and the black line
The neck x-ray above displays this patient’s problem. The Black dash line is the path a normal curve should take in the neck normal curve. Now compare this with the red line. The red line is tracing the path of the curve or lack of a curve that this patient’s neck is taking. That red line is an illustration of cervical dysfunction.
Look at where the C1 is so far forward from the normal curve. This is cervical curve collapse. Eventually, the C1 is going to hit all the structures in the front of the neck including the vagus nerve, the glossopharyngeal nerve, and the spinal accessory nerve.
A brief explanation of the cervical spine alignment goals
Restoring a normal cervical curve is paramount to the treatment of a patient diagnosed and suspected of having cervical instability. Below are images of the types of cervical spinal curvatures we routinely encounter in our patients. How did these necks get this way? They could be the result of impact injury whether in sports, whiplash, or work-related problems. What these necks routinely have in common is cervical spine ligament weakness and damage, commonly referred to as cervical ligament laxity as a possible leading factor in curvature problems of the neck.
To further demonstrate these problems the image “cervical degenerative dysstructure” also shows the progressive nature of cervical instability leading to a breakdown of the cervical curve. this can result in destructive forces being placed on vital neurovascular structures including the spinal cord.
Cervical spine ligaments, are they the answer to neck curvature problems?
Cervical spine patients do a lot of research. Their health problems are so vast and sometimes so complex that research provides many patients a degree of comfort through understanding. In some of our very well-read patients, we can hear the arguments they have been given to proceed with surgery as the “only answer.” Again, for some patients, surgery is the only answer. But it is not always the case.
Here is something typical of what we hear in our consultations:
Symptoms related to vagus nerve compression
The symptoms of vagus nerve compression are vast: Here are some of my articles where vagus nerve compression is implicated:
Symptoms related to glossopharyngeal nerve compression
In the book Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. (x) Dr. H. Kenneth Walker describes symptoms related to glossopharyngeal nerve compression:
“Glossopharyngeal nerve lesions produce difficulty swallowing; impairment of taste over the posterior (back) one-third of the tongue and palate; impaired sensation over the posterior one-third of the tongue, palate, and pharynx; an absent gag reflex; and dysfunction of the parotid gland (problems of salivation.)
These symptoms and conditions are discussed in our articles:
When you have cervical dysstructure, the C1 rotates and becomes subluxed (or dislocated or mis-locates) out of its normal position. So your C1 is not where it is supposed to be. Now, in this moving out of place, the C1 will drag, stretch and put tension on the spinal cord, the vagus nerve, the carotid artery, and the internal jugular vein.
Once you start stretching the carotid artery, the artery that supplies blood to the brain, you narrow the arterial opening. Simply that means you get less blood flow into the brain.
Once you start stretching the jugular vein, you diminish the vein’s ability to drain the blood from the brain. You get fluid to back up in the brain. This will cause issues of brain fog, dizziness, head pressure, and eye pressure, pain, and blurry vision.
When you stretch the vagus nerve at C1 you may develop the cardiac-like symptoms of tachycardia. As the vagus nerve helps calm the body down, if your vagus nerve is getting stretched and the nerve impulses sent and received by the vagus nerve are distorted, you get develop anxiety, your emotional state can be in a constant state of being on edge. The vagus nerve is part of the mechanism that controls inflammation. If the vagus nerve is compromised you may develop chronic inflammation throughout your body. This may lead to a diagnosis of fibromyalgia or multiple chemical sensitivity or mast cell activation or POTS. The underlying cause of many of these conditions can be low vagal tone or dysautonomia.
Compression on the brain stem
Compression on the brain stem not only occurs when the bones of the neck press on them. Compression on the brain stem also occurs when the bones of the neck start wandering and stretching and pulling on the brain stem. The brain stem becomes elongated. This causes the relay centers of the brain stem, such as the nausea center which is right next to the medulla (see below) right above the spinal cord. So a person may have nausea. A person may have unexplained shortness of breath. Your respiratory center is right above the spinal cord. I’ve had patients who feel that they have to think about breathing. It is possible cervical dysstructure has affected their breathing center.
A paper in the medical journal The Neurologist (2) suggested that the “control of ventilation (breathing) depends on a brainstem neuronal network that controls the activity of the motor neurons innervating the respiratory muscles. This network includes the pontine respiratory group and the dorsal and ventral respiratory groups in the medulla. Neurologic disorders affecting these areas or the respiratory motor unit may lead to abnormal breathing.
Manifestations associated with disorders of this network include sleep apnea and dysrhythmic breathing frequently associated with disturbances of cardiovagal and sympathetic vasomotor control. Common disorders associated with impaired cardiorespiratory control include brainstem stroke or compression, syringobulbia (syrinx), Chiari malformation, high cervical spinal cord injuries, and multiple system atrophy.”
“Patients with degenerative cervical myelopathy (DCM) often present with atypical symptoms such as vertigo, headache, palpitations, tinnitus, blurred vision, memory loss and abdominal discomfort.”
A January 2022 study in the journal World neurosurgery (3) found
“Patients with degenerative cervical myelopathy (DCM) often present with atypical symptoms such as vertigo, headache, palpitations, tinnitus, blurred vision, memory loss and abdominal discomfort.” The researchers of this study then aimed to investigate the relationship between atypical symptoms of degenerative cervical myelopathy and the segments of spinal cord compression.
How did they do it”
166 degenerative cervical myelopathy patients with atypical symptoms were divided into vertigo, headache, blurred vision, tinnitus and palpitations groups according to their atypical symptoms; while the typical group was 214 degenerative cervical myelopathy patients with typical symptoms only.
The incidence of vertigo 37%,
The incidence of headache 18%,
The incidence of blurred vision 15%,
The incidence of tinnitus 11%.
Compared to the typical group, patients in the blurred vision and tinnitus group were older and the incidence of spinal cord compression at C3-5 in the vertigo group, C4-5 in the headache group and C6-7 in the palpitation group was higher.
The scores of vertigo, headache and palpitations decreased after surgical decompression, whereas only vertigo and headache scores decreased after non-surgical treatment.
Atypical symptoms were common in patients with degenerative cervical myelopathy and the segments of spinal cord compression might be associated with specific atypical symptoms. Surgical treatment is effective in relieving some of the atypical symptoms.
What are we seeing in this image?
The brain stem and spinal cord in relation to the C1 and C2. The medulla oblongata, as just outlined, plays a vital role in communicating signals between the spinal cord and the brain that controls heartbeat, respiration, and the nausea center among other functions.
Summary and contact us. Can we help you? How do I know if I’m a good candidate?
We hope you found this video informative and it helped answer many of the questions you may have surrounding Craniocervical Instability, upper cervical spine instability, cervical spine instability, or simply problems related to neck pain. . . Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.
1 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] 2 Nogués MA, Benarroch E. Abnormalities of respiratory control and the respiratory motor unit. The neurologist. 2008 Sep 1;14(5):273-88. [Google Scholar] 3 Yuan H, Ye F, Zhou Q, Feng X, Zheng L, You T, Cao R, Feng D. The Relationship between Atypical Symptoms of Degenerative Cervical Myelopathy and the Segments of Spinal Cord Compression: A Retrospective Observational Study. World Neurosurg. 2022 Jan 26:S1878-8750(22)00089-4. doi: 10.1016/j.wneu.2022.01.075. Epub ahead of print. PMID: 35092814.