C1 Stability Over Time, and the “Holding” of your Correction.


Cervical and general spinal stability over time, and the “holding” of your correction has much to do with the completeness of your realignment through the NUCCA procedure, i.e., the measurable reduction of the Atlas Subluxation Complex.


Let me elaborate.


There are three main bones which participate in the formation of the misalignment complex, or what upper cervical specialists refer to as the Atlas Subluxation Complex (ASC). The focus point, or “Hub” of the ASC involves the top two bones of the neck and the base of the skull, hence the condition is intimately associated with the upper spinal cord, pre-cranial arteries (vertebral, and to some degree carotids), venous drainage from the skull and the vagus nerves. These top three bones belong to the axial skeletal system. Namely, the Occiput (O), the Atlas (C1) and the Axis (C2). Each of these bones has unique joint surfaces and features which allow them to articulate normal movement of the head and upper neck. These three separate structures (O-C1-C2), function as a unit, by “design”. They meet the requirements of stability and mobility. They are unique to the axial skeletal bones because unlike their spinal segments below, they have no interlocking joints with one another, thus, they have great mobility. To counteract their mobility, they are tethered together with connective tissues called ligaments which give them their over-all stability in motion. Stability is vital because these structures protect, support and are in such close proximity to the brainstem, vertebral arteries, cerebrospinal fluid and spinal nerves. Yes, they must be mobile in all three planes and around all three axes as shown below.


The Three Cartesean Planes


Looking at the anatomy, we see that at the base of the skull, on right and left sides of the foreman magnum (the “big hole” through which the central nervous system and vertebral arteries pass) extend two little pediment like structures which we call the condyles. (Condyle is Greek for “knuckle”) These condyles are anatomically shaped to nest securely on the top surface of the Atlas bone. And, if perfectly replaced into proper alignment, the Atlas accommodates them quite nicely, like two little marbles resting in their circular indentations on a Chinese checker board. If properly replaced, this joint becomes much more stable as spastic muscular contractions in the neck and back relax instantly. This is only the top part of the picture. The Atlas is also resting on the top surface of the Axis. The Atlas, on its bottom side has two slightly concave impressions that rest upon the slightly convex joint surfaces atop of C2. The Atlas can slip-slide around on in between these surfaces, and if it goes beyond a certain point, it can become locked into any number of stressed positions between the skull and the Axis. When this occurs, upper cervical specialists describe this as a subluxation. When this structural distortion adversely affects the neuro-vascular centers we’ve described above, we call this an Atlas Subluxation Complex. Angular imbalance in this area causes the spine to twist and distort below, making it more susceptible to injury, pain patterns and degeneration. If uncorrected, the patient can become a constellation of symptoms. The CT image below (top) is of a fractured Atlas, with a break through the surface that supports the condyle. Surgical stabilization is required initially, then reduction of the subluxation is essential. The Image below, in the middle is a schematic side view of how Atlas (shown in yellow) rotates around the dens of the Axis (green). The bottom image is an X-ray showing a rotated Atlas on Axis. No surgery should be performed in this condition, but rather the NUCCA procedure should be used to reduce this subluxation.


Atlas on Axis (fractured lateral mass) Atlas on Axis (subluxated)


The NUCCA procedure is a spinal alignment corrective technique which entails the following elements:


  1. X-ray protocols and standards for radiographic measurement and numerical description of the ASC.
  2. A motor skill sequence of the upper cervical doctor deployed in correcting the ASC.
  3. Clinical correlations and interpretations of patient signs and symptoms.

To reduce the spinal misalignment, there must be a force exerted into the Atlas. That effort (forces) transmit upward to the skull and downward to the spinal segments below. If the Atlas is not moved “just right”, and completely reduced to its proper orientation between the skull and the Axis, the instability in this area will persist, even though the symptoms may in fact began to improve. Likely, you will begin to feel better, but you may find that you don’t “hold your correction” as long as you like. As mentioned above, NUCCA doctors take special X-rays of Atlas Subluxation/misalignment in order to calculate how to correct it. We take X-rays that correspond to the X, Y and Z planes as illustrated in the first image above. I have inserted the three basic views, namely, the Lateral (“Y” plane), Nasium (“Z” plane) and Vertex (“X” plane) views as shown below. These views provide valuable information through their analysis on how the upper cervical structures are mal-positioned. If the alignment of the X-ray machine is off, then the image of the anatomy will contain the distorted “perspective” of the X-ray machine and will present a radiographic picture that is inaccurate.