Digital Motion X-ray: Finding the missing cause of headaches, dizziness, and facial pain

Ross Hauser, MD. Hauser Neck Center, Caring Medical Florida
Brian R. Hutcheson, DC. Hauser Neck Center, Caring Medical Florida

Many patients with cervical spine instability have been chasing a diagnosis for years. At some point these people, probably you or your loved one, start to realize that their chase is nowhere near the end point because they continue to have worsening symptoms and continue to receive ineffective treatment with the addition of possibly unneeded medications that do not help. In our office, one of our diagnostic tools is a Digital Motion X-ray. We use tool because it can help reveal a missing diagnosis.

Digital Motion X-ray helped reveal a series of  missing diagnoses

For many people, a digital motion x-ray can reveal a series of  missing diagnoses and possibly end your chase for that elusive diagnosis that finally responds well to treatment. A digital motion x-ray is exactly what it is sounds like. It is a moving picture x-ray. In this video,  Dr. Brian Hutcheson, DC shows how digital motion x-ray helped reveal a series of  missing diagnoses in the case of a  woman in her mid-30’s who happened to be a mother of three.

Video transcript summary and explanatory notes:

Headaches, neck pain, lightheartedness, dizziness, facial pain, and trigeminal neuralgia.

  • This is the case of a 35 year-old mother-of-three suffering from headaches, neck pain, lightheartedness, dizziness and facial pain that can be known as trigeminal neuralgia. We are going to show you her digital motion x-ray.
  • Digital motion x-ray allows us to examine your neck as your head and neck travel through different ranges of motion. This provides us more information on what is happening in your neck than what we would see in a conventional or static image “snap shot.”

What this mom’s neck reveals

At 0:36 of the video the motion image of her neck

  • The first thing we see in her digital motion x-ray is that she has lateral C1 tilting. Some of you may understand this as lateral head tilting. Lateral head tilting has not only been linked to these following problems, but these following problems have also been shown to be difficult to accurately diagnose. This is why the we believe in the value of the digital motion x-ray in uncovering the missing diagnoses in the cervical spine.

Head, neck, jaw and face pain

In our many years helping people with chronic pain of the head, neck, jaw and face we have seen many people with a diagnosis of Trigeminal neuralgia. For some of these people, possibly including yourself, it was not easy getting this diagnosis as this problem can be confusing and frustrating to understand. Not only for the patient but the doctor alike. The problems of diagnosis to determine where you source of facial, head and jaw pain is coming from is covered in our article: The evidence for Trigeminal Neuralgia non-surgical treatments.

Painful, involuntary muscle spasms in the neck 

  • Lateral head tilting is linked to: Torticollis, painful, involuntary muscle spasms in the neck with a resulting head rotation and tilting to one side. In the 2020 medical publication STAT Pearls, the authors noted, “There may be several presenting positions, including flexion, extension, right or left tilt (in Torticollis.) (1) See our article Cervical dystonia and spasmodic torticollis treatment.

Dizziness, loss of balance, sometimes nausea, sometimes vomiting

  • Lateral head tilting is linked to: Benign paroxysmal positional vertigo or BPPV. Some of you reading this article may have been offered this diagnosis with a somewhat reassuring tone that your dizziness, loss of balance, sometimes nausea, sometimes vomiting is something that can be managed, may go away on itself, and this will be more of a nuisance than anything. That is why it is called “Benign.” For some people indeed, this does happen, for many patients we see, the dizziness did not go away and it continues on. Please see our article Cervical Vertigo and Cervicogenic Dizziness.

The patient’s lateral head tilt and a discovered problem

At 0:45 of this video, the motion of the patient’s neck reveals the head tilt problem

In this image the tilting of the C1 in visualized on the digital motion x-ray. This tilted has created a visual space or a "hole," that you can see through this patient's cervical spine. That hole is not suppose to be there. In essence, the C1 vertebrae bone, which sits between the occiput or the base of the skull and the 2nd bone of the neck of vertabrae (c2) has moved out of place and is causing the patient's symptoms of Head, neck, jaw and face pain

In this image the tilting of the C1 in visualized on the digital motion x-ray. This tilted has created a visual space or a “hole,” that you can see through this patient’s cervical spine. That hole is not suppose to be there. In essence, the C1 vertebrae bone, which sits between the occiput or the base of the skull and the 2nd bone of the neck of vertebrae (C2) has moved out of place and is causing the patient’s symptoms of Head, neck, jaw and face pain.

The tilting in visualized on the digital motion x-ray. This tilted has created a visual space or a “hole,” that you can see through this patient’s cervical spine. That hole is not suppose to be there. In essence, the C1 vertebrae bone, which sits between the occiput or the base of the skull and the 2nd bone of the neck of vertebrae (c2) has moved out of place and is causing the patient’s symptoms of Head, neck, jaw and face pain. This hole demonstrates cervical spine instability and the cause of this mom’s problems. Please see our article Occipital neuralgia and Suboccipital headache – C2 neuralgia treatments without nerve block or surgery for more on the headache problem and cervical spine instability.

A vanishing hole – a missed opportunity to make a correct diagnosis

Video portion 1:30 – 1:30 

The value of the digital motion x-ray versus traditional x-ray is seen in this segment of the video. In motion the C1 tilting is seen and “unseen,” depending on the position of this patient’s head.

Here the “hole” is seen at the C1, the triangular shape that the yellow arrow is pointing to.

Above the abnormal tilting of the C1 is visualized. As we ask the patient to start moving her head and her heads reaches a more neutral position, meaning that she’s not flexed (her chin is in her chest) or extended (her chin is pointed in the air), but in a neutral position (chin pointing straight ahead), we can see that that tilting disappears. So conventional or static x-ray imaging whether you go to the hospital you go to your doctor’s office, if they only take the standard neutral position x-ray, they will miss the C1 head tilting. To them, the neck is just fine.

Here Dr. Hutcheson demonstrates the patient’s head in the more neutral position. The C1 tilt can not be seen in this position and therefore cannot be diagnosed. This leads to a missed opportunity to help a patient now and for years to come.

Here Dr. Hutcheson demonstrates the patient's head in the more neutral position. The C1 tilt can not be seen in this position and therefore cannot be diagnosed. This leads to a missed opportunity to help a patient now and for years to come.

Here Dr. Hutcheson demonstrates the patient’s head in the more neutral position. The C1 tilt can not be seen in this position and therefore cannot be diagnosed. This leads to a missed opportunity to help a patient now and for years to come.

If you have symptoms of headaches, neck pain, lightheartedness, dizziness, facial pain, and trigeminal neuralgia and you get the standardized neutral poistion x-ray at the doctor’s or hospital, we just saw that you would miss the C1 tilt.

The problem of posterior ponticulus revealed

At 1:45 of the video:

The next thing that we see, that may not be discovered by conventional x-ray is that the patient, this mother of three, has a unilateral posterior ponticulus and what that is it’s a fancy word for a little bone formation at the C1 that sits by her vertebral artery. The vertebral artery is one of the major supplies of blood  between the brain and the spine. So when you have posterior ponticulus,  any injury to that upper cervical spine is going to leave the patient more prone to headaches, dizziness, lightheadedness, or simply a feeling of being a little bit off-balance, and neck pain. This problem can also be causing our patient’s vertebral blood supply loss.

In this image from the video and article Understanding Ponticulus Posticus, Ross Hauser, MD explains that in advancing cervical spine instability and neck problems, and with seemingly no alternative, the posterior atlantooccipital ligament transforms itself into a bony structure to “bridge” over the foramen in a last attempt to prevent vertebral artery and suboccipital nerve compression. A last chance to fight off cervical instability.

In this snap shot from the video belwop, Dr. Hauser shows the development of Ponticulus Posticus in a Digital Motion X-Ray of a patient. Dr. Hauser explains that with seemingly no alternative, the posterior atlantooccipital ligament has transformed itself into a bony structure to "bridge" over the foramen in a last attempt to prevent vertebral artery and the suboccipital nerve compression.

In this snap shot from the video belwop, Dr. Hauser shows the development of Ponticulus Posticus in a Digital Motion X-Ray of a patient. Dr. Hauser explains that with seemingly no alternative, the posterior atlantooccipital ligament has transformed itself into a bony structure to “bridge” over the foramen in a last attempt to prevent vertebral artery and suboccipital nerve compression.


C1-C2 – the anterior posterior open mouth view reveals cervical dysfunction in motion and more clues to the cause of the patient’s symptoms.

If you went to the hospital or your doctor and they suspected a problem in your upper cervical spine, they may recommend an anterior posterior open mouth (APOM)  x-ray view. This again would be a “snap shot,” or an image of a single moment. The difference with digital motion x-ray is that we are able to watch your neck move in real time and see how in real-time motion how your C1-C2 interact and work, or not work together.

Digital motion X-ray showing C1-C2

This is another of our videos, it gives a clearer view of the DMX demonstrating C1-C2 instability in another patient.

  • Digital Motion X-ray is a great tool to show instability at the C1-C2 Facet Joints
  • The amount of misalignment or “overhang” between the C1-C2 demonstrates the degree of instability in the upper cervical spine.
  • This is treated with Prolotherapy injections (explained below) to the posterior ligaments that can cause instability.
  • At 0:40 of this video, a repeat DMX is shown to demonstrate correction of this problem.

In the case of the mother of three, the patient if Dr. Hutcheson’s video, her digital motion x-ray reveled a similar problem. In her situation her C1 (Atlas)  has slipped over the second bone the (C2) axis. This contributes to headaches, neck pain, a feeling of light-headedness, feeling dizzy and not feeling yourself to getting tired more often to having problems with concentration artery in your blood supply it can really cause a lot of problems being such a very important area connecting your brain to the rest of your body.

  • DMX is ideal for anyone who has suffered a whiplash, concussion, or other neck injury and has developed chronic symptoms.
  • DMX can be especially helpful when MRI and static X-ray showed “nothing” but you still have chronic symptoms.

While the patient featured in this article suffered from headaches, neck pain, lightheartedness, dizziness, facial pain, and trigeminal neuralgia, many patients report more or different symptoms that can also be traced to upper cervical spine instability and whose causes can be demonstrated by digital motion x-ray.

These can include facial numbness, tinnitus (ringing in the ears), burning sensations, fatigue, racing heart, exhaustion, weakness, pressure in the sinuses and behind the eyes, and others. Digital Motion X-ray (DMX) can often provide the doctor and patient the answers to these strange clusters of symptoms.

The involvement of DMX in discovering a difficult to find diagnosis is covered in these articles on specific symptoms:

Treating and repairing cervical instability with Prolotherapy: research papers

References

1 Cunha B, Tadi P, Bragg BN. Torticollis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 13, 2020. [Google Scholar]

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