Cervical Instability in the EDS Population A. AtiqDurrani, MD Center For Advanced Spine Technologies Cincinnati, OH
Cervical Spine Issues in EDS • C1-C2 instability • Cranio-cervical Instability. • Lower Cervical kyphosis. • Cervical disc degeneration ( Most common at C4-5, C5-6). • Chiari Malformation
Common Symptoms of Cervical Instability • Occipital headaches • Neck pain • Passing out at the extremes of lateral rotation • Choking sensations • Base of skull tenderness • Jaw pain
MRI with Flexion and Extension • What we look for: • Cleido-clivus angle • Grubbs Oak distance • Distance between clivus and dens • Cranial settling/Chiari malformation • Subluxation of vertebrae
% uncovering of facets • Blue line measures the C2 facet. • Green line measures the amount of C1 facet that covers C2. • With these numbers, % uncovered can be calculated.
Treatment Asymptomatic- Observation
Treatment • Symptomatic • Physical Therapy- • Cranio-Sacral Alignment. • Cervical Collar.
Treatment • Interventional Pain Procedures. • Occipital nerve Blocks • Cervical Epidural / Foraminal Injections.
Treatment • If Conservative means fail to control symptoms , then Cervical Spinal Fusion is the preferred Surgical Treatment.
Symptomatic C1-C2 instability in EDS patients can be surgically treated with a C1-C2 fusion
Outcomes • Between 1/2009 and 8/2011, N= 25. • 1 year follow up. • All patients underwent stabilization for C1-C2.
Outcomes. • Mean Pre-op Pain – 8 • Mean post op pain at one year- 2 • One patient still had residual pain. • Screw fracture in one patient. • Headaches resolved in 92% of patients. • Will you do this procedure again – 95%.
Conclusion • Cervical Spinal Instability is a common reason for EDS patients suffering from headaches and Cranio-Cervical pain. • It is under- appreciated by the spine community and not very well understood. • In many circumstances, patients complaining of such complaints go through extensive work up with no treatment offered in the end. • Stabilization of O-C1-C2, complex resolves cranio-cervical symptoms in EDS patients.