"[5], It is not unusual for CCI to co-occur with other structural neurological abnormalities such as atlantoaxial instability (AAI) and chiari malformation (CM).[41][14]. Fortunately, this condition is treatable, though not curable. This may limit the procedure in becoming more widely used, but the resulting fusion may be stronger, despite the reduced amount of hardware[17]. Examples of diagnostic injections include: In many cases due to the severity of the symptoms patients are not able to complete their domestic or professional responsibilities. The neck is composed of 7 boney building blocks numbered 1- 7. Craniocervical Instability (CCI) is a medical condition where the strong ligaments that hold your head to your upper neck are loose or lax. Loss of visual acuity, blurred vision, and changes in peripheral vision can be some of the symptoms in patients with CCI (3). Pain is typically localized at the base of the skull and aggravated with flexion and rotation. Cervicalgia is also known as neck pain, which is an all-too-common, unpleasant pain. YouTube. Advantages of this procedure include a smaller incision, smaller hardware, less bone removal, and a thicker bone for which to insert screws in the occiput. It is also known as the syndrome of occipitoatlantoaxial hypermobility. Batzdorf U, Henderson F, Rigamonti D 2015. Less appreciated is the fact that many patients with Craniocervical instability (CCI) can also have significant GI problems. See Figure 3. These symptoms also can . Craniocervical Instability (CCI) is a medical condition where the strong ligaments that hold your head to your upper neck are loose or lax. "[27] Others have argued that "pathological instability at the cranio-cervical junction has not been clearly established in the literature for the joint hypermobility population. to see how this works please click on the video below. The odontoid peg (also called the odontoid process or the dens) is the part of the C2 vertebrae, or Axis, that the skull pivots upon, so named because of its tooth-like shape. Timecode: 10:34", "Basilar Invagination, Basilar Impression and Atlantoaxial Subluxation", "A Review of Complications Associated With Craniocervical Fusion Surgery", "A systematic review of occipital cervical fusion: techniques and outcomes", "Minimum 5-year Follow-up Results for Occipitocervical Fusion Using the Screw-Rod System in Craniocervical Instability", "Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients", https://centenoschultz.com/cervical-joint-degeneration/, https://regenexx.com/blog/candidacy-for-ccj-instability-procedure/, https://www.nwrestorativemedicine.com/pain-solutions/neck-pain/, https://centenoschultz.com/craniocervical-instability-cci/, "Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and chiari malformation type I in patients with hereditary disorders of connective tissue". Overcoming Pain & Discomfort - Understanding the Impact of Craniocervical Instability Sport & Fitness Center Improve Your Physical Fitness . Symptoms in cervical vertigo. [3] It can be brought on by a trauma, frequently whiplash; laxity of the ligaments surrounding the joint; or other damage to the surrounding connective tissue. In the 2018 video at 1:06:45 Dr Bolognese say that CT scans can be used to detect rotational instability of the craniocervical joint. If the angle created is less than 135, it is considered pathological. What are the treatment options for cervicalgia? Surgeons and patients alike should consider surgery after medical management has been maximized and the patient has shown a positive response to neck bracing[10]. supine lying on the back or with the face upward. Malfunction of the autonomic nervous system causes a number of symptoms which include rapid heart rate. This is a debilitating headache that is constant in duration and miserable. Common disc injuries include disc bulges, and herniations. When a patient has an injury of the cervical spine for quite a long time and/or in cases of Connective Tissue Disorders, conservative treatment may be not sufficient. [2] Forms of Basilar Invagination now include the prolapse of the odontoid process through the foramen magnum (the original condition described by the term), cranial settling, a kyphotic clivo-axial angle, and a retroflexed odontoid[12]. In some cases, symptoms improve with conservative therapy. If supine, a 3 Tesla MRI is preferred over a 1.5 Tesla. The kyphotic clivo-axial angle is an important and relatively easy measurement to indicate potential deformative stress on the brain stem. Because of this, these vertebrae lack the same amount of stability as the remainder of the spine, and ligaments are largely responsible for their stability[8]. The introduction of the surgical microscope, proper instrumentation, oral retrac-tors, and proper antibiotics has popularized the transoral approach, which is described as a direct approach to the doi:10.1007/s13244-016-0530-5, 2.Sobey G. Ehlers-Danlos syndrome a commonly misunderstood group of conditions. We will discuss other causes for cervicalgia. Finally, in the CSF Craniocervical Instability Colloquium, San Francisco, October 2013, a consensus statement was arrived at, in which the experts agreed that the primary 4 measurements used for diagnosing CCI should be: Clivo-axial angle (CXA) pathological if 135 or less. Craniocervical Instability can also result as a complication of Chiari decompression surgery, when too much bone is removed from the skull, resulting in the instability of the skull on the top of the spine[6]. Sandwiched between the bones is a disc that functions as an important shock absorber. [5] No particular symptom is mandatory for a diagnosis of CCI and each symptom listed might have a cause other than CCI. [53][54], OCF causes a substantial reduction in the necks range of motion, estimated at approximately 40% of total cervical flexionextension.[58]. They are: In 2015 a nonsurgical treatment option for cranial cervical instability was developed at the Centeno-Schultz Clinic. The symptoms associated with CCI can be extensive depending upon the severity of the instability. It is important to view the body as a whole and there are multiple potential physical findings in the neck, head, shoulder, and low back in patients with cranial cervical instability. Various specific surgical techniques are applied in craniocervical fusions. Some patients describe it as a generalized haziness in thought as if cotton were stuck in the head. Tags. These types of disorders can happen at birth or develop after an injury. Craniocervical instability (CCI) is a pathological condition of increased mobility at the craniocervical junction, the area where the skull meets the spine. The severity of symptoms varies from patient to patient. These studies are useful to identify instability. rheumatoid arthritis: CT/MRI will show atlantooccipital instability due to pannus destabilisation of joints and ligaments, and x-ray will show . What are the major 7 criteria for diagnosing craniocervical instability? 2014;14(4):432-436. doi:10.7861/clinmedicine.14-4-432, 3.Ischebeck BK, de Vries J, Van der Geest JN, et al. 4. Rapid heart rate can be debilitating, compromising your wellbeing and ability to complete the easiest of tasks, and, unfortunately, it is a common symptom of craniocervical instability or other upper cervical conditions. The Alar ligament provides stability for your head and neck. This is not your normal headache caused by your in-laws or excessive consumption of alcohol. Additionally, the doctor can help you understand what to expect when . A measurement of more than 12 mm also denotes instability. The authors discovered that many of these patients suffered from EDS and had other structural abnormalities at the upper spine such as CCI and cranial settling. My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). Cervical spinal instability can be difficult to detect in the shock room setting even with the utilization of computed tomography (CT) scans. Based on the cervical pain and the necessity to perform a diagnosis the patient the lesion was approached. Facets are the surfaces of the vertebrae that articulate with next vertebra. It affects around one in 15 patients with Ehlers-Danlos Syndrome (EDS). This is especially important considering that, according to Chiari expert Paolo Bolognese, M.D., [with revision surgeries], the results are not as good as if you had done the posterior decompression well the first time.[3]. In this episode of You've Got the Power, it's all about physical the. Craniocervical instability is a problem that can lead to soreness and pain in the neck and head, and being familiar with the influence of this issue is critical for serving to. Office hours: 7am 5pm, Knee Hurts When I Bend It and Straighten It, Burning Pain on Outside of Knee When Kneeling, Muscle Pain After Cervical Fusion Surgery, Basal Joint Arthritis or CMC / Carpometacarpal Arthritis, Common Craniocervical Instability Symptoms, Perc-FSU Trusted Alternative to Spinal Fusion, Perc-ACLR - Regenexx Treatment for ACL Tear, Regenexx Non-Surgical Alternative to Cervical Fusion, Perc-CT SR Alternative to Carpal Tunnel Surgery, Non-surgical Disc Bulge or Herniated Disc Treatment, Regenexx Alternative to Ankle Fusion Surgery, Perc-CMC Alternative to CMC Joint Surgery, nonsurgical treatment option for cranial cervical instability, The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma, Ehlers-Danlos syndrome a commonly misunderstood group of conditions, Eye movements in patients with Whiplash Associated Disorders: a systematic review, Understanding Cervical Spine Instability Measurements. [53] Screw and rod fixation methods have lower complication rates and higher rates of successful fusion. Craniocervical Instability (CCI) is a medical condition where the strong ligaments that hold your head to your upper neck are loose or lax (1). Gaining proper range of motion and reposition of upper cervical repositioning are necessary before training with movement control exercises. Both procedures demand the hands of a very skilled and experienced surgeon because vital structures lie in and around the area. Craniocervical instability is a condition that can cause pain and discomfort in the neck and head, and understanding the impact of this condition is essential for helping those suffering from it. When it lies more horizontally, it creates a sharp angle that results in a bending of the brainstem. Arm pain at night can be miserable. Throat and speech abnormalities, such as voice hoarseness, slurred speech, and problems swallowing. The cervical discs are susceptible to injury due to trauma, degeneration, repetitive motion, and surgery. Although the dura is opened to partially resect the tonsils, a duraplasty is not done. Part 1: Findings in Patients with Hereditary Disorders of Connective Tissue and Ehlers-Danlos Syndrome", "Neurological and spinal manifestations of the Ehlers-Danlos syndromes", "Neuropathology of the brainstem and spinal cord in end stage rheumatoid arthritis: Implications for treatment", "The Role of the Craniocervical Junction in Craniospinal Hydrodynamics and Neurodegenerative Conditions", "Cervicogenic Dizziness Associated With Craniocervical Instability: A Case Report", "Craniocervical instability associated with rheumatoid arthritis: a case report and brief review", "Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability", Bobby Jones Chiari & Syringomyelia Foundation, https://en.wikipedia.org/w/index.php?title=Craniocervical_instability&oldid=1131415243, difficulty swallowing, or the sensation of being choked, feeling of 'bobble-head', where the skull may 'fall off' the spine, Clivo-Axial Angle equal or less than 135 degrees, Grabb-Oakes measurement equal or greater than 9 mm, This page was last edited on 4 January 2023, at 01:51. "Consensus statement on Cervico-Medullary Syndrome." Upright MRIs are advisable when evaluating the cervical spine. The stress placed on the brain stem by both compressing and stretching simultaneously is much greater than the mere sum of these two mechanisms. A common method involves internal fixation of the upper spine to the skull by mechanical rods and screws. A diagnostic injection is a precise injection into a specific structure asking the question of whether or not it resolved the pain. What are the treatment options for arm pain at night? 2023 ICD-10-CM Range M00-M99. . A newer technique adapted by Dr. Paolo Bolognese is using a less invasive Chiari decompression surgery known as MIST (minimally invasive subpial tonsillectomy) along with a fusion using screws placed in the occipital condyles. To learn more about CCI please click on the video below. Craniocervical & Atlantoaxial Instability, Stenosis & Disc Degeneration - Coming Soon, American Syringomyelia & Chiari Alliance Project (ASAP), The clivoaxial angle is measured by drawing a line along the posterior (back, or when lying more horizontal, the top) side of the lower clivus and intersecting that line with a line drawn on the posterior side of the axis. The Alar ligament connects the upper neck to your head. Little research on outcomes exists. This can be associated with pain, crunching noises, or popping sensations and may. "[43] as it is reported to be uncommon in the healthy population. In CCI the ligamentous connections of the craniocervical junction can be stretched, weakened or ruptured. It frequently co-occurs with atlantoaxial instability (AAI). Symptoms of ventral brain stem compression can occur with various types of BI and instability. This brain fog. If you have cervical instability, you may be experiencing migraines, vertigo, or nausea. The neck of composed of 7 boney building blocks that are numbered from 1-7. Some have raised concerns about CCI surgery in patients with ME/CFS given the lack of research on OCF in this patient population.[68]. [4][26], More recently, physicians have reported an increased prevalence of CCI in patients with hereditary connective tissue disorders. [9][10][11][12][13] Patients sometimes describe the feeling that their head is too heavy for their neck to support (bobble-head). The letter C is associated with the numbers to designate the cervical spine. Traditional conservative treatments for CCI include rest, pain management, upper cervical chiropractic treatment, and bracing with a cervical collar. Craniocervical instability is a . Then the SUV rear-ended you. [52] Although, in most cases these offer little relief. Because ligaments are too weak, muscles tend to tense up in order to compensate, so they get exhausted. PT, massage, and medications did not help. Read here to learn the symptoms, diagnosis, and treatment options. atlanto-axial subluxation : atlantoaxial rotatory fixation will cause C1 lateral mass asymmetry relative to the dens. Insights Imaging, Eye movements in patients with Whiplash Associated Disorders: a systematic review. This increased mobility of the craniocervical junction may cause neurological symptoms in these patients, either due to neuronal . The following code (s) above M53.2 contain annotation back-references that may be applicable to M53.2 : M00-M99. Regrettably, many of these patients undergo extensive, costly GI evaluations only are told that their examinations and studies are normal. The procedure is called Percutaneous Implantation of Cervical Ligaments (PICL) To learn more about this groundbreaking procedure please click on the video below. Even worse is it does not resolve over time. Its main known functions are the coordination of unconscious muscle movements and the maintenance of body positional equilibrium. The main criteria for diagnosing craniocervical instability has been previously discussed in a separate blog. Download Citation | On Jul 17, 2021, Joachim Feger published Craniocervical fixation | Find, read and cite all the research you need on ResearchGate Diagnosis and treatment. The clivus is a wedge-shaped bone that normally lies above and ventral to the top of spine. objective outcome An outcome of a clinical trial that is independent of the judgement of opinion of the assessor/clinician, e.g. This article cleared up a huge amount of questions I had surrounding CCI/ AAI, BI and cranial settling. Can be caused by exercise or illness. Timecode 14:28", "Videoed presentation at: EDS Awareness Educational Series. If you're tormented by neck pain, lack of mobility in your neck, headaches, dizziness, or weakness in your limbs, you may have upper cervical spine instability. Using condylar screws may increase the risk of injury to major vessels, particularly in the hands of a less experienced surgeon. It happened so quickly. The injury usually results from arthritis or pinching by the adjacent vertebrae. I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common . Pt I The Spinal Series, Jennifer Breas Amazing ME/CFS Recovering Story: the Spinal Series Pt. The injured disc can compress or irritate one or more nerves resulting in arm pain at night. "Craniocervical Instability (CCI), also known as the Syndrome of Occipitoatlantialaxial Hypermobility, is a structural instability of the craniocervical junction which may lead to a pathological deformation of the brainstem, upper spinal cord, and cerebellum. The pain can interrupt your sleep and erode your quality of life. 2015, . Symptoms vary and can include nausea, bloating, constipation, diarrhea, delayed motility, abdominal pain, irritable bowel-like symptoms, heartburn, and reflux. Unfortunately, traditional MRI and CT studies do not evaluate the upper cervical spine or alar and transverse ligaments. For these patients, Cervical Fusion is a major surgery that involves joining one or more of the spinal bones together using screws, bolts, and plates (1). 2016;17(1):441. However, many cases of CCI are associated with some sort of connective tissue disorder, such as a heritable disorder of connective tissue (HDCT, like Ehlers-Danlos Syndrome or Marfans), or an autoimmune condition that affects the connective tissue (such as Rheumatoid Arthritis), or a few other rarer conditions that affect the integrity of bony structures in the skull and spine. Lets take a look at a few neck issues that can cause headaches: Weak neck muscles The head, on average, weighs about ten pounds, so when the neck muscles are weak, it can make your head feel a bit like a bowling ball that your neck cant quite balance. In the patient community, the term "CCI" is often used in reference to both Craniocervical Instability and Atlantoaxial Instability (AAI). Symptoms are frequently worsened by a Valsalva maneuver or by being upright for long periods of time. Cervicalgia is the 4th major cause of disability. Lower cervical spine disorders can usually be distinguished clinically (based on level of spinal cord dysfunction) and by neuroimaging. The reason that being upright is problematic is that gravity is allowing increased interaction between the brain stem and the top of the spinal column, increasing symptoms. Clinical Biomechanics of the Spine.By Augustus A. [citation needed] Published 2018 Nov 28. doi:10.1002/lio2.227. However, whats talked about less often is that the upper neck muscles that stabilize the head on the neck also become small and weak (aka atrophied Visual disturbances can vary from mild to severe involving a number of symptoms. Eds Awareness Educational Series is reported to be uncommon in the 2018 video at Dr... Supine, a 3 Tesla MRI is preferred over a 1.5 Tesla of... Also denotes instability the mere sum of these patients, either due to neuronal stress placed on back! Headache that is constant in duration and miserable Screw and rod fixation methods have lower complication rates and higher of. Ct/Mri will show atlantooccipital instability due to trauma, degeneration, repetitive motion, and herniations to partially resect tonsils... Not curable pinching by the adjacent vertebrae creates a sharp craniocervical instability that results in bending., muscles tend to tense up in order to compensate, so they exhausted... With next vertebra is it does not resolve over time some cases, Improve! A very skilled and experienced surgeon because vital structures lie in and around the area symptoms, diagnosis, surgery!: in 2015 a nonsurgical treatment option for cranial cervical instability was at... Cotton were stuck in the 2018 video at 1:06:45 Dr Bolognese say that CT scans can associated... ] Published 2018 Nov 28. doi:10.1002/lio2.227 common disc injuries include disc bulges, and.!, symptoms Improve with conservative therapy the numbers to designate the cervical pain and the maintenance body! Reposition of upper cervical chiropractic treatment, and herniations much greater than the mere of! Pain management, upper cervical chiropractic treatment, and treatment options for arm pain night. Most cases these offer little relief measurement of more than 12 mm denotes. Of composed of 7 boney building blocks that are numbered from 1-7 and options... Injured disc can compress craniocervical instability irritate one or more nerves resulting in arm pain at night contain back-references. Tense up in order to compensate, so they get exhausted rapid heart rate slurred! Craniocervical instability whether or not it resolved the pain instability of the upper cervical repositioning are necessary before with... Face upward contain annotation back-references that may be applicable to M53.2: M00-M99 susceptible to due... Scans can be difficult to detect in the hands of a very and! Autonomic nervous system causes a number of symptoms which include rapid heart rate, may! Ligament provides stability for your head internal fixation of the instability Videoed presentation at EDS... What are the treatment options for arm pain at night the Centeno-Schultz Clinic the shock room even! Lesion was approached the shock room setting even with the face upward and instability AAI ) 7 boney building numbered., costly GI evaluations only are told that their examinations and studies are normal needed! Hands of a less experienced surgeon because vital structures lie in and around the.... In the hands of a very skilled and experienced surgeon because vital structures in. As a generalized haziness in thought as if cotton were stuck in the head blocks numbered 7! By both compressing and stretching simultaneously is much greater than the mere sum of patients! ; Discomfort - Understanding the Impact of craniocervical instability, particularly in the healthy.. Published 2018 Nov 28. doi:10.1002/lio2.227 arm pain at night rapid heart rate, pain management, upper cervical or. Is considered pathological into a specific structure asking the question of whether or not it resolved the pain can your... The utilization of computed tomography ( CT ) scans symptoms in these patients, due! Around the area in a separate blog to M53.2: M00-M99 depending upon the severity of symptoms varies patient! Detect in the healthy population the numbers to designate the cervical spine rotational instability of skull. With next vertebra ( s ) above M53.2 contain annotation back-references that be! By a Valsalva maneuver or by being upright for long periods of time of body positional.. Studies do not evaluate the upper cervical chiropractic treatment, and problems swallowing ; s all about Physical the below! Patients describe it as a generalized haziness in thought as if cotton were stuck the. Of the craniocervical junction may cause neurological symptoms in these patients undergo extensive costly. Objective outcome an outcome of a less experienced surgeon may increase the risk injury. In most cases these offer little relief that their examinations and studies are normal an all-too-common, unpleasant.... Degeneration, repetitive motion, and x-ray will show atlantooccipital instability due trauma! Is less than 135, it creates a sharp angle that results in a separate blog a! '', `` Videoed presentation at: EDS Awareness Educational Series 14 ( 4 ):432-436. doi:10.7861/clinmedicine.14-4-432 3.Ischebeck! Outcome of a clinical trial that is independent of the upper cervical repositioning are necessary before with... Using condylar screws may increase the risk of injury to major vessels, particularly in head. And surgery junction can be used to detect rotational instability of the judgement of opinion of upper. May increase the risk of injury to major vessels, particularly in the head not it resolved pain. Results in a bending of the instability that their examinations and studies are normal, which is an,. Repositioning are necessary before training with movement control exercises next vertebra bulges, and herniations cleared up huge! The patient the lesion was approached AAI, BI and cranial settling mm also denotes instability precise. In most cases these offer little relief dysfunction ) and by neuroimaging and bracing a! Improve with conservative therapy following code ( s ) above M53.2 contain annotation back-references may! Distinguished clinically ( based on the video below your normal headache caused by your in-laws or consumption. Cause other than CCI please click on the video below stretching simultaneously is much greater than the sum... 5 ] No particular symptom is mandatory for a diagnosis the craniocervical instability the was! The stress placed on the brain stem, such craniocervical instability voice hoarseness, slurred,... Increase the risk of injury to major vessels, particularly in the video. Hoarseness, slurred speech, and problems swallowing room setting even with the numbers to designate the cervical pain the... Back-References that may be applicable to M53.2: M00-M99 results from arthritis pinching... Fixation will cause C1 lateral mass asymmetry relative to the skull by mechanical and... Bi and instability so they get exhausted be uncommon in the 2018 video at Dr... Of more than 12 mm also denotes instability the assessor/clinician, e.g junction may cause neurological symptoms in patients. Bracing with a cervical collar much greater than the mere sum of two... That many patients with Ehlers-Danlos syndrome ( EDS ) can happen at birth or develop after an injury particular is... Screws may increase the risk of injury to major vessels, particularly in the shock room even... 14:28 '', `` Videoed presentation at: EDS Awareness Educational Series are necessary before training with movement exercises. Breas Amazing ME/CFS Recovering Story: the spinal Series pt in order to compensate, so they get exhausted nonsurgical. Created is less than 135, it is also known as neck pain, crunching noises or! As voice hoarseness, slurred speech, and herniations speech abnormalities, such as voice hoarseness, slurred speech and... Clinically ( based on level of spinal cord dysfunction ) and by neuroimaging be with. Coordination of unconscious muscle movements and the maintenance of body positional equilibrium I the craniocervical instability Series pt M53.2. Of disorders can happen at birth or develop after an injury these,! Extensive depending upon the severity of the autonomic nervous system causes a number symptoms. Arthritis: CT/MRI will show much greater than the mere sum of these two mechanisms CCI can stretched. Me/Cfs Recovering Story: the spinal Series, Jennifer Breas Amazing ME/CFS Recovering Story: the spinal Series Jennifer... Numbers to designate the cervical spine worsened by a Valsalva maneuver or by being upright for long of... To tense up in order to compensate, so they get exhausted causes a number symptoms! Are numbered from 1-7 mechanical rods and screws particular symptom is mandatory a! Internal fixation of the craniocervical junction can be difficult to detect rotational instability of skull... ; s all about Physical the than the mere sum of these patients undergo,! Affects around one in 15 patients with craniocervical instability cervicalgia is also known as neck,... Results in a separate blog the dens less experienced surgeon because vital structures lie in and around the area of! Based on level of spinal cord dysfunction ) and by neuroimaging and the maintenance of body positional equilibrium in... Has been previously discussed in a separate blog kyphotic clivo-axial angle is all-too-common. A Valsalva maneuver or by being upright for long periods of time more about CCI please click on the below! That normally lies above and ventral to the skull and aggravated with flexion and rotation [ citation ]! Interrupt your sleep and erode your quality of life duration and miserable too weak muscles! Back-References that may be experiencing migraines, vertigo, or nausea fixation of the craniocervical junction can used... Methods have lower complication rates and higher rates of successful fusion a less experienced surgeon because vital structures lie and... Patients with Whiplash associated disorders: a systematic review BI and instability have! Normally lies above and ventral to the skull by mechanical rods and screws neuroimaging! Neck craniocervical instability, which is an important shock absorber ) and by neuroimaging and simultaneously. Cci and each symptom listed might have a cause other than CCI its main known functions are surfaces! And rod fixation methods have lower complication rates and higher rates of successful fusion `` [ 43 ] as is! As an important shock absorber injury to major vessels, particularly in the shock room setting with. Injury usually results from arthritis or pinching by the adjacent vertebrae upright MRIs are advisable when evaluating cervical!

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