Team „cervical spine instability“


A condition such as cervical spine instability, especially cranio-cervical instability, needs a team approach – most importantly regarding diagnostics.

Although, radiological imaging can clearly show CCI, there are several other disciplines that can help to discover the full extent of this condition.

The following will give a brief overview of the possibly involved disciplines and their potential benefits.

Primary Care Physician: This is the central point for the patient’s health care. The PCP keeps track of all results, sees the big picture, supports applications for health insurance issues and disability, prescribes medications and physical therapy and helps in general to deal with one’s conditions.

Neurosurgeon: Similar to the PCP, but more focused on CCI; specifically recommends therapeutic approaches and potential surgery and may order additional diagnostic testing.

Radiologist / Neuroradiologist: Evaluates MRI, CT and X-ray images. Compares old and new images and supports the neurosurgeon with decision making. Provides recommendations for additional testing.

Neurologist: Neurology is a very important area, but unfortunately often they do not really want to deal with CCI. Nevertheless, neurologists offer tests that could support a diagnosis of CCI, for example nerve conduction studies, sensory evoked potentials, EEG, neuropsychiatric tests. All those tests could indicate spinal cord damage, autonomous nerve system disorders or brain stem damage.

One small part of neurology specifically tests for autonomous nerve system dysfunction (Dysautonomia)

Another specialized area of neurology is called otoneurology which might show disturbances between the brain stem, eye movement and hearing.

Patients that suffer from bowel or bladder dysfunction can visit neurourologists or neurogastroenterologists.

Orthopedics: The orthopedics is similar to neurosurgeons, but more focused on non-invasive strategies to treat your instability. He or she can help the patient to decide whether surgery should be considered, or treat one post-surgery. Furthermore, an orthopedist might also support the patient with any requests concerning insurance or disability.

Physical therapist: PT’s cannot only suspect CCI by using specific manual testing methods, but can also draw conclusions about which nerve might be damaged by testing different muscle groups. Furthermore, they take care of the patient’s non-invasive treatments before and after surgery, and in the best case they prevent the patient from needing surgery. PT’s are probably the most important team member.

Paraplegiology: As the name suggests, the paraplegiology deals mainly with patients that suffer from spinal cord damage, but they might be useful for cervical spine instability too.

Internal medicine / environmental medicine / holistic medicine: There are some supportive nutritional treatment concepts that might improve some symptoms of CCI.