Treatment of Craniocervical Instability

 The goal of treatment of Craniocervical Instability is gaining more stability in the cervical spine. This should be done by, first, conservative treatment. The latest option is invasive treatment and it is highly recommended to try everything before getting any surgery. 

Conservative treatment

Conservative treatment of Craniocervical Instability can consist of correcting cervical misalignment, improving overall posture and training muscles that are compensating for lax ligaments. It depends on each patients’ situation and underlying cause which treatment he or she needs. Which results a patient can achieve with a certain treatment method depends on the situation as well. Below you can find some of the options for conservative treatment. 

Atlas Orthogonal (AO)

AO is an upper cervical specific chiropractic technique that utilises a gentle, calibrated instrument to correct misalignments of the atlas (C1), relative to the skull base (occipital bone). X-rays of the head and cervical spine are used to make mathematical measurements and evaluation of the misalignment.


NUCCA, National Upper Cervical Chiropractic Association, is a treatment method that focuses on correcting misalignment of the upper cervical spine.  Like AO, X-ray views are used to make mathematical measurements and to see how the cervical spine is misaligned.

Chiropractic Biophysics (CBP)

Many patients with CCI have a so-called “reversed curve” due to instability. The primary goal of CBP is optimal posture, spinal alignment and curve correction. In the same time, improvement and pain and functionality is another desired outcome. It is important to find out whether or not a patient is ready to correct the curve. 

Physical Therapy

It can be useful for patients with CCI to retrain muscle balance in order to gain more stability. Muldowney Protocol is a Physical Therapy method that focuses on patients with EDS. It is important to search for a Physical Therapist who is experienced with CCI. When ligaments are not strong enough yet, is possible a patient is not ready for doing physical therapy exercises.

Sacro Occipital Techique (SOT)

In SOT, spinal subluxations and postural distortions in the body are assessed and corrected. The most significant pattern is the relationship between the sacrum (Sacro) and occiput (Occipital). Normal structure and function of the musculoskeletal body, brain and spinal cord will be restored. 

Neck collar treatment

Wearing a neck collar can help some patients managing their symptoms and support the other treatments they are doing. Most patients wear a neck collar around 3 times a day for 20 to 30 minutes.

Regenerative Medicine


In Prolotherapy joints are injected with dextrose. It promotes an inflammatory response of the injected ligaments, the body will try to heal the inflammation and ligaments will be strengthened. It has been applied for many years for joints such as knees and elbows. It can also be applied in the cervical spine, where posterior capsule ligaments are injected.

Platelet-Rich Plasma (PRP)

PRP is the injection of concentrated platelets (5-6x the concentration in the blood) releases growth factors to stimulate recovery in non-healing soft tissue injuries. It is injected in posterior capsule ligaments and surrounding muscles. The goal is to heal posterior ligaments and thus to create more stability. A few weeks after the procedure it is recommended to start doing light exercises. 


    Posterior Stem cell & PICL

    If PRP fails, patients can try Posterior Stem Cell therapy, where stem cells are injected in posterior ligaments by using your own bone marrow. If anterior ligament damage is primarily causing instability, PICL can be useful. In PICL stem cells are injected in the anterior ligaments. Please note stem cell therapy is still an investigational method, but so far there are good results and it can prevent patients from getting surgery. 

    Please watch this video from dr. Centeno from the Centeno-Schultz clinic and learn more about regenerative stem cell procedures for Craniocervical Instability. 

    Invasive treatment

    Occipitocervical fusion

    Fusion of the upper cervical spine is a highly invasive procedure that you would rather like to prevent. Unfortunately for some patients who have severe instability and brainstem compression, it is impossible to avoid surgery as it can be even life threatening.

    With occipitocervical fusion, the upper cervical spine (C1 and C2) and the skull get fused, to avoid any movement. This is called a “short fusion”. A “long fusion” can go from the skull to T2. The good news is that many patients get relief of their symptoms, though the downfall is that the range of motion of their head and neck will be greatly reduced. 

    Fusion can only be performed by a neurosurgeon who is highly skilled in this type of surgery.