Sunday, 19 June 2016

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Could my atlas (C1) really be misaligned?

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January 29th, 2012
I have had scoliosis from a young age that has given me constant pain. I am now 24 years old. I went to see a TMJ specialist because of popping in my jaw and while he decided that my jaw is not a big deal, he said that all the unbearable pain I have been experiencing in my neck and back all these years, as well as the migraines, are a result of a misaligned atlas. He concluded this based on the pain I feel all over my head, neck and face when they are even lightly touched. He said there is someone in his office that specializes in atlas realignments

In the past year, I have had a brain MRI, a cervical and lumbar MRI, and full back and neck x-rays. All of the doctors (neurologist, orthopedist) who did the MRIs and x-rays OR looked at them during second opinion consultations said that there were no structural problems with my neck. Could it possibly be true that over a dozen different doctors in the past 20 years have missed a misaligned C1, or even the 6 doctors I've seen the past year?

The realignment is both pricey and time consuming so I really want to get some opinions before I commit to them.
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replied January 30th, 2012
Especially eHealthy

It would be highly doubtful that a significantly malaligned C1 would be missed on all of those studies, by that many different physicians.

Alignment of the C1 is best seen on the good old C-spine series, specifically of the open mouth (or odontoid) view. This view is specifically to look at the odontoid and the lateral masses of C1. This view is very sensitive and specific for alignment of C1.

C1 alignment would can also be seen on certain cuts of a CT scan or MRI. It is something that is routinely looked at when reading a C-spine study.

Is this person who is going to realign your C1 a physician? I'm not sure I would want someone messing around with my C1 who is not exceptionally trained in cervical spine anatomy and in treating any problems that might arise. This is not an area to be taken lightly. Many chiropracters attribute all patient's ills to "malaligned spinal segments" and offer great relief with their continuous manipulations. Though an occasional massage is great for back pain, I'm not sure I would want anyone trying to rotate my C1, if it is really significantly malaligned.

Again, significant malalignment of the atlas (atlantoaxial instability) usually results in torticollis, which would be very evident on physical exam and C-spine films. You can always ask your radiologist to review the C-spine x-rays and cervical MRI, specifically for the alignment of the atlas. It would be easy to do.

I don't know about this realignment procedure. Atlantoaxial instability, though it is painful in acute traumatic cases, many times does not have any discomfort associated with it. Some children have it congenitally and it is a cause of facial asymmetry. Some kids and adolescents develop it after a case of sore throat. And, again, there are traumatic cases of it, but it is very obvious. Some cases of torticollis is caused by asymmetric muscle pull, but that is not what is being discussed here. It is the torticollis caused by rotation of the C1.

This is only my opinion, but you may want to get more information about this realignment procedure. It sounds a little shady to me.

Good luck.

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