Post-Traumatic Instability of the Cervical Spine

Ross Hauser, MD, Caring Medical Florida

Chronic Post-Traumatic Instability of the Cervical Spine: Persistent neck pain that develops into hearing, vision, and swallowing problems, dizziness, and chronic headaches.

We often see patients who have suffered from a significant injury to the neck, such as a whiplash injury or sports-related injury, who continue to have post-traumatic neck pain and instability despite many years of treatments following acute care. Acute care in some cases included immediate surgery following the injury. Some of these people have been told the root of their problem was that following their injury, they were not correctly diagnosed, correctly treated or in some cases, after the acute management phase of the injury, even believed that their pain was worsening. As is the case with many neck pain sufferers who doctors may dismiss symptoms as being all in the mind. You may be one of these people.

If you are indeed one of these people then you are already familiar with the treatments that did not work for you.

For many people, these treatments can be very effective and helped them resume a good quality of life. These are typically not the people we see in our offices. We see the people for whom these treatments have failed and cervical fusion surgery is the “only,” available option. For some people, fusion surgery may be the only option and many people may have good results. These are also not the people we typically see in our office. We see the people who had post-traumatic neck pain, the failed conservative treatment, the fusion surgery, and now have the common complication of adjacent segment disease. So what do we do to help them? Let’s review the research and a case history so we can present an option.

Chronic Post-Traumatic Instability: The injured posterior ligamentous complex and the cervical intervertebral disc

In this section, I will briefly describe what is happening in your neck. Understanding the damage and weakness exhibited by the cervical neck ligaments can help understand why your past treatment may have not worked for you and what can be done to repair this damage with the goal of alleviating your symptoms.

Many patients we see who suffered a significant neck injury will typically not exhibit a singular symptom. They will exhibit multiple symptoms.

These include but are not limited to:

These symptoms can come from cervical spine ligament damage. This is demonstrated in the illustration below as a torn interspinous ligament; a thinned ligamentum flavum; torn capsular ligaments; and a torn posterior longitudinal ligament.

Post-Traumatic Instability of the Cervical Spine is rarely a problem of one isolated injury to a single structure in the neck. Damage to multiple ligament structures is more often the cause.

In this illustration post-traumatic instability of the cervical spine is rarely a problem of one isolated injury to a single structure in the neck. Damage to multiple ligament structures is more often the cause. These injuries are demonstrated here as a torn interspinous ligament; a thinned ligamentum flavum; torn capsular ligaments; and a torn posterior longitudinal ligament.

In this illustration post-traumatic instability of the cervical spine is rarely a problem of one isolated injury to a single structure in the neck. Damage to multiple ligament structures is more often the cause. These injuries are demonstrated here as a torn interspinous ligament; a thinned ligamentum flavum; torn capsular ligaments; and a torn posterior longitudinal ligament.

Understanding the posterior ligamentous complex and how damage to its components create chronic post-traumatic instability of the cervical spine


Posterior ligamentous complex damage was seen as responsible for an increased local range of motion (hypermobility) at the injured level C4-C5  by 77.2% and  C6-C7 by 190.7%

In a May 2020 study, (1) French and Canadian researchers looked at the injured posterior ligamentous complex and the cervical intervertebral disc and their roles in post-traumatic instability in the cervical spine.

The posterior ligamentous complex (the ligaments at the back of your neck and head) act to stabilize the cervical spinal column and prevent your head from hyper-flexion (your head bending too far forward with your chin buried into your chest), hyper-rotation, and translation (hypermobility where the ear may crash into the shoulder or your head snaps too far to the left or the right). In your research or discussions with your doctors, the posterior filamentous complex may also be referred to as the posterior tension band and it is called this in certain medical studies.

In this study, the researchers gave this assessment of post-traumatic instability in the cervical spine.

So what the researchers did was create a computer model to simulate the impact of certain injuries to the posterior ligamentous complex and intervertebral disc injuries and measure the consequences.

The conclusion of this study? “Stabilization appears important when managing patients with soft tissue injuries.”

It does not take much damage to the posterior ligamentous complex to send you into cervical spine instability problems

A study in the European Spine Journal (2) showed how significant the cervical spine stabilizers are and how significant injury can be in starting a cascade of degenerative neck disease. Here the researchers examined cadaver  C6-7 segments: supraspinous/interspinous ligaments; ligamenta flavum; facet capsules, and facet joints. A robot-based testing system performed repeated flexibility testing of flexion-extension, axial rotation, and lateral bending.

What they found was:

Damaged ligaments in the facet joint capsule

Above I noted that the facet joint capsule, implicated in the injured posterior ligamentous complex is an area of connective tissue that covers and closes the facet joint (the joint that connects two vertebrae together and allows proper spinal movement).

In 2014 headed by Danielle R. Steilen-Matias, PA-C, our Caring Medical team published these findings in The Open Orthopaedics Journal. (3)

When the capsular ligaments are injured, they become elongated (stretched out) and exhibit laxity (as with anything that is stretched out, the ligaments have now become loose). Loose ligaments cause and allow excessive movement of the cervical vertebrae.

Capsular ligament laxity can occur instantaneously as a single macro trauma, such as a whiplash injury, or can develop slowly as cumulative microtraumas, such as those from repetitive forward or bent head postures. In either case, the cause of injury occurs through similar mechanisms, leading to capsular ligament laxity and excess motion of the facet joints, which often results in cervical instability.

So how does this impact you? A case history of a 47-year-old woman – headaches, chronic pain in the neck and upper limbs, and intermittent tingling in one arm. Treated with simple dextrose injections.

We published a case history in the Journal of Prolotherapy (4) of a 47-year-old woman. Her symptoms were headaches, chronic pain in the neck and upper limbs, and intermittent tingling in one arm. Her pain was made much worse when she moved her head. She had crunching and cracking sounds coming from the C0 – C2, and severe spasms and tenderness in the trapezius and paraspinal muscles.

The patient was treated with dextrose Prolotherapy at each of four visits over five months. Prolotherapy is a simple injection technique. We have documented its success in helping patients with cervical spine instability in the research articles listed below. A detailed explanation of Prolotherapy is given following the patient’s case history:

Case history notes:

Recommendations are given to the patient:

Prolotherapy treatment

We will use this video to help you understand the treatment. This video jumps to 1:05 where the actual treatment begins.

This patient is having C1-C2 areas treated. Ross Hauser, MD, is giving the injections.

In the case history we are exploring in the 47-year-old woman:

In this video, DMX displays Prolotherapy before and after treatments that resolved problems of a pinched nerve in the cervical spine


In this video and explanatory notes, Ross Hauser, MD explains the various unresolved symptoms that you may be suffering from that can be traced to upper cervical spine instability. This is a good overview of our treatment program. Use this contact form with questions.


Treatment of Upper Cervical Instability with Prolotherapy

Ross Hauser, MD at Caring Medical Florida.  Notes of this video are below with time marks.

Tension on the spinal cord

(1:26 of video)

When a person has cervical instability, specifically upper cervical instability, there is a greater tension on the spinal cord. The spinal cord can pull on the brainstem. This pull or traction can cause all kinds of problems within the relay centers that are in the brainstem.

The vertebral artery runs in the transverse foramen of the cervical vertebrae. If the cervical vertebrae are moving too much you can get compression the artery that supplies about 1/3 of the brain with its blood.

The vertebral artery runs in the transverse foramen of the cervical vertebrae. If the cervical vertebrae are moving too much you can get compression of the artery that supplies about 1/3 of the brain with its blood.

Loss of blood flow to the brain

(At 2:22 of the video)

Intracranial pressure (At 3:05 of the video)

Vision problems

Trigeminal nerve and trigeminal neuralgia (4:45 of the video)

It is well known in neurology, that trigeminal neuralgia and even migraine headaches are because of irritation of the trigeminal nerve. It turns out that the cervical trigeminal nucleus in the spinal cord goes all the way down to C3 so upper cervical instability can affect this nucleus which can give you facial pain can give you trigeminal neuralgia can give you Cervical dystonia and spasmodic torticollis all kinds of cranial nerve symptoms.

Treating and repairing cervical instability with Prolotherapy: research papers

If you have questions and would like to discuss your cervical spine issues with our staff you can get help and information from us.

1 Beauséjour MH, Petit Y, Hagen J, Arnoux PJ, Thiong JM, Wagnac E. Contribution of injured posterior ligamentous complex and intervertebral disc on post-traumatic instability at the cervical spine [published online ahead of print, 2020 May 28]. Comput Methods Biomech Biomed Engin. 2020;1-12. doi:10.1080/10255842.2020.1767776 [Google Scholar]
2 Hartman RA, Tisherman RE, Wang C, Bell KM, Lee JY, Sowa GA, Kang JD. The mechanical role of the posterior column components in the cervical spine. European Spine Journal. 2016 Jul 1;25(7):2129-38.[Google Scholar]
3 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]
4. Hauser R, Steilen-Matias D, Fisher P. Upper cervical instability of traumatic origin treated with dextrose prolotherapy: a case report. Journal of Prolotherapy. 2015;7:e932-e935.

 

 

 

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