Diagnose Craniocervical Instability

Diagnosing Craniocervical Instability is not easy, primarily due to the fact many doctors and other health care professionals are not familiar with this chronic problem. 

On this page you can find more information about the importance of patient history, diagnostic testing, imaging and diagnostic criteria. Please scroll down to learn more.

Patient history

The first step in diagnosing Craniocervical Instability is to know more about each individual patient history.


Patients with CCI are dealing with a wide range of neurological symptoms and tend to get worse when they are upright. Symptoms are listed on the symptoms page. Be mindful many other syndromes share similar symptoms.


One of the causes of CCI is a neck trauma. It is important to know whether a patient had an accident with a motor vehicle, history of surgeries or improper chiropractic manipulations.

Connective Tissue Disorders

Many patients with CCI tend to have hereditary Connective Tissue Disorders such as Ehlers Danlos Syndrome. In itself is not equate to CCI, but those with EDS have a higher % chance of Cranio-Cervicogenic complications.

Autoimmune Disorder

Inflammatory autoimmune responses that affect the joints, such as Rheumatoid Arthritis. Bone spurs and inflammation are important signs.  These affect the overall health of joints and ligaments.

Chiari Malformation

It is not uncommon for patients to have Chiari Malformation or low lying tonsils. If this is visible on a supine MRI, it would be warrant to perform further diagnostic testing of the cervical spine.

Family history

It is common for patients with hereditary disorders such as EDS or joint autoimmune diseases to have family members with similar problems. 

Physical signs of Craniocervical Instability

Joint Hypermobility

A common cause for Craniocervical Instability is the Ehlers Danlos Syndrome (EDS). It can be assessed by physical examination: the Beighton Score. It measures joint hypermobility on a 9-point scale. One point can be allocated for the ability to perform each.

CCJ Measurements

To see if there is upper cervical instability, neurosurgeons perform measurements of the Craniocervical Junction on scans that are made. Scroll down see what scans patients should get to get properly diagnosed.

Please note measurements alone are usually not sufficient to diagnose CCI. 

Diagnostic testing for Craniocervical Instability

Craniocervical Instability is a dynamic problem, which means it can only be determined by dynamic imaging procedures in different positions, rather than static imaging.

Upright MRI

CCI diagnosis is given by performing an Upright MRI that allows evaluating the craniocervical junction in an upright position as well as the evaluation of the patients’ anatomy in flexion & extension and neck rotation.

Digital Motion X-ray (DMX)

A DMX is an upright x-ray while you’re moving your neck around in flexion, extension, rotation and side-bend. We can see in which motions the cervical spine is moving around too much, hence, we can determine which ligaments are affected.

Cone Beam CT (CBCT)

An upright CBCT of the cervical spine can also be performed in neutral, flexion, extension and rotation. The advantage of a CBCT is that you can perform measurements accurately and you are able to generate 3D images.

X-Rays (Stills)

With a proper series of X-Rays much can be achieved. X-Rays should be upright and include:

  • Neutral
  • Flexion & Extension
  • APOM
  • Nasium