The rapid flexion/extension, compression, and rotation of the cervical spine that commonly occurs in motor vehicle collisions can result in trauma that includes facet derangement, disk injury, and ligament sprain or rupture, frequently occurring in the upper cervical region. When the upper cervical spine exhibits excessive motion in combination with pain and other neurological symptoms, the patient may receive a diagnosis of upper cervical instability (UCIS).

Upper cervical instability can be seen on x-ray as anterior translation of the first cervical vertebrae (C1) over the second cervical vertebra (C2) exceeding 3.5 mm on a flexion (forward bending) stress x-ray. It can also be observed as lateral translation of C1 on C2 of more than 2.0 mm of lateral overhang of the lateral mass of C1 over C2 as noted on frontal view x-ray with an open mouth during side bending end-range loading. This is also measured by asymmetry of the periodontal space or the gap between the dens (a protrusion at the front of the vertebrae) of C2 and lateral mass (thicker boney areas on the sides of the vertebrae) of C1. Patients with UCIS often have a loss of normal cervical curve (lordosis), which can place increased force on the intervertebral disks and facet joints.

Although UCIS patients have the option for surgical fusion of C1-2, like all spinal fusion surgeries, there are associated risks and complications, not to mention the invasive approach, the expense, and future ramifications (including reduced range of motion and its negative impact on the adjacent cervical vertebral levels). This can result in the need for further treatment down the line, including additional surgical procedures, which can have a negative effect on quality of life.

Fortunately, there are non-surgical treatment options available to the UCIS patient, including chiropractic care. In a September 2023 case-series study, nine patients with radiographically confirmed UCIS and loss of cervical lordosis underwent a chiropractic treatment regimen directed primarily at restoring normal cervical lordotic curve. Treatment included three specific types of cervical traction and chiropractic spinal manipulation rendered at an average frequency of twice a week. In all nine cases, the patients reported significant symptomatic and functional improvements, with cervical lordosis and UCIS improvements observed on x-rays.

Doctors of chiropractic are well trained in the diagnosis and management of upper cervical instability, as well as pathologies that frequently occur with whiplash. The good news is that many patients experience positive outcomes as a result of a multimodal treatment approach. However, in cases that are more complex or when more invasive treatments are necessary, the patient will be referred to the appropriate healthcare provider.