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  • Instability in c1 and c2

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    Old 07-31-2014, 09:58 PM   #1
    misstawnie's Avatar
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    Instability in c1 and c2

    Hello! I'm new to these forums and am looking for information on cervical instability.

    I went to my rheumatologist (I was diagnosed with JRA at age 3) since I have been having shoulder pain. I mentioned that I have had some headaches and neck pain as well, and my doctor sent me off for cervical x-rays with obliques.

    My doctor later informed me that I should see an orthopedic surgeon because I have "instability in c1 and c2." I have made an appointment, but it's still a month away.

    I am incredibly scared -- I'm only 28 and a mother of a 3 year old. The doctor didn't seem to elaborate on the instability, so I'm left Googling this situation...which isn't helping too much. I've seen my options (halo/neck braces, fusions, prolotherapy..) and I'm very worried. I've seen some people complaining of horrible pain after fusion surgery. Doctors do not really acknowledge the pain because the main goal of the surgery is stabilization.

    I understand the risk with this situation, but the surgery comes with a lot of risks as well. I'm sure I'll end up getting a CT scan or MRI to further assess the damage and severity of the instability; but I'm looking for people who have been in my shoes and understand the worry and prognosis of this condition.

    Does anyone have any insight or advice on this condition and the outcomes? Thanks in advance!

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    Old 08-03-2014, 10:43 PM   #2
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    Re: Instability in c1 and c2

    I don't know the extent of your instability, but instability at that level is rare in the "normal" population. More severe instability (3mm at c1/c2 for adults) is fairly common in people with RA (25 - 80% of people are affected).

    The good news is that the spinal canal is wide at that juncture so cord trauma is relatively less likely. The bad news is if there is cord trauma and myelopathy at this level very serious complications are possible. There is a Medscape article on this phenomenon where people with RA suffer C1/C2 instability. You can look for "Atlantoaxial Instability" at

    THe symptoms you describe don't seem to really fit the myelopathy pattern so it's possible they are unrelated (or only vaguely related as in instability can cause vertebrae to rub causing neck pain for instance). An MRI will tell you more about the C1/C2 level and also the condition of the rest of your cervical spine. That information along with consultation with trusted spine surgeons will hopefully give guidance on the preferred course of action. Let us know how it goes and Good Luck.

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    Old 10-21-2014, 09:30 PM   #3
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    Re: Instability in c1 and c2

    i would say try prolo first as it is less dangerous and very successful

    Old 10-22-2014, 12:21 PM   #4
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    Re: Instability in c1 and c2

    Welcome to the board. First of all, try not to worry or be scared. Yes, you will need a MRI to be able to see what is going on...and you should see either a fellowship-trained orthopedic SPINE surgeon or a neurosurgeon whose practice is limited to the neck and back for an accurate diagnosis and plan of treatment.

    Rather than being frightened, use that energy to learn basic spinal anatomy, common diseases of the spine, and related terminology. This way, when you get in to see the spine specialist, you will have some understanding of what he/she discusses with you, and will be able to participate in formulating a plan for treatment.

    An x-ray reveals very little information other than the alignment of the bones of your spine and whether there are any fractures. Did he do a flexion/extension x-ray? If not, it would be difficult to tell if there is instability.

    Try not to worry. It will only serve to increase your headaches! Surgery will only be considered as a last resort.

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    c1 c2, c1 c2 fusion, cervical fusion, cervical fusion post op

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