Acquired Upper Cervical Disorders and Your Spine

An overview of head and upper neck abnormalities that may develop after birth and later in life.

While some head and upper neck conditions are congenital (present at birth), others develop later in life due to injury or a separate condition. When a condition forms after birth, it is called an acquired disorder.

This article describes some common acquired upper cervical disorders. These conditions, also called craniovertebral junction (CVJ) abnormalities or craniocervical disorders, occur at the base of the skull at the top of your cervical spine (your neck).

This article provides an overview of the following acquired upper cervical disorders:

  • Basilar Invagination
  • Cervical Rheumatoid Arthritis
  • Degenerative Arthrosis (Degenerative Joint Arthritis, Spondylosis, or Spinal Osteoarthritis)
  • Synovial Cysts at C1-C2
  • Pseudogout

If you would like to learn about upper cervical disorders present at birth, read Congential Upper Cervical Disorders.
The brain and brainstemThe brainstem includes the Midbrain, Pons and Medulla Oblongata.Basilar Invagination
Basilar invagination occurs when the second bone in your cervical spine, which is called the axis (or C2), moves up and back toward your skull’s base. When your C2 is in this abnormal position, it can cramp the space occupied by your spinal cord and brainstem.

Acquired basilar invagination can occur after a serious injury, such as a fall or bicycle accident. Conditions, such as rheumatoid arthritis, can also cause it.

The severity of symptoms depends on how much the spinal cord, brain stem and/or other key nerves and vascular structures are affected. Some people may experience minimal symptoms, and are able to manage the condition with conservative measures like physical therapy and anti-inflammatory medication. On the other hand, others may have neurological symptoms (such as dizziness, weakness, tingling, and numbness) that often require surgical treatment through a decompression and spinal fusion approach.

Cervical Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune disorder that can wreak havoc on joints throughout your body. In your upper neck, it can attack the atlanto-axial joint between the top 2 bones in your spine—the atlas, or C1, and the axis, C2.

The atlanto-axial joint allows for healthy rotation in your neck, but it can cause the C1 and C2 to become misaligned when it’s affected by RA. Misalignment and instability can impinge your spinal cord, brainstem and/or other nerves, which can cause pain and other serious neurological symptoms.

People with RA in their upper cervical spine may have radiating pain in their head and neck, numbness in their hands or feet, and respiratory problems. The condition is also associated with spinal deformity, including scoliosis and loss of cervical lordosis.

Treatment largely depends on whether the spinal cord is affected by the C1-C2 misalignment. If the spinal cord isn’t being compressed, your doctor may opt to fit you for a cervical collar and/or prescribe a nerve block for pain management. If the spinal cord is affected, your doctor may recommend a decompression and fusion of the C1 and C2 bones to reinstate stability to your upper spine.

Degenerative Arthrosis (Degenerative Joint Arthritis, Spondylosis, or Spinal Osteoarthritis)
Degenerative arthrosis is a type of arthritis that can disrupt the atlanto-axial joint. This type of arthritis is also called degenerative joint arthritis, spondylosis, or spinal osteoarthritis. Unlike rheumatoid arthritis, is type of arthritis is degenerative in nature and linked to aging. But, like RA, it can cause abnormal motion at the atlanto-axial joint between C1 and C2, potentially cramping the spinal cord and requiring surgery. If the spinal cord is not compromised, your doctor may recommend more conservative options, such as medication therapy, to manage your pain.

Synovial Cysts at C1-C2
Synovial cysts are benign (non-cancerous) fluid-filled sacs that can develop in spinal facet joints as a result of joint degeneration. While this type of cyst is most often found in facet joints in your lumbar spine, they can occur within the atlanto-axial joint between C1 and C2.

If the cyst isn’t impacting your spinal cord or surrounding nerves, you might not experience any symptoms or require treatment outside of observation. However, if the cyst causes joint problems that result in spinal cord compression, your doctor may recommend surgery to remove the cyst and decompress the spinal cord. After the cyst removal and decompression, your spine surgeon may perform a spinal fusion to create stability in your upper cervical region.

You can explore more about these cysts, including additional information about common symptoms and treatment, in Synovial Cysts in the Spine.

Pseudogout
Pseudogout occurs when crystals of calcium pyrophosphate dihydrate build up in one or more joints. The crystals can cause inflammation and joint damage. In the upper cervical spine, pseudogout can cause crowned dens syndrome, which occurs when the crystal deposits surround the peg-like structure called the dens in the axis (C2).

Symptoms of pseudogout and crowned dens syndrome include neck stiffness, pain at the skull base and back of the head, and fever. Your doctor will typically opt for non-surgical therapies to manage your pain and inflammation, such as nonsteroidal anti-inflammatory drugs and/or corticosteroid injections.
Atlas (C1) and Axis (C2)Acquired Upper Cervical Disorders and Quality of Life
Learning you have any type of upper cervical problem can be scary. But, keep in mind there are many types of treatments—both conservative (non-operative) and/or surgical—that can help manage your symptoms and increase your quality of life. Keep the lines of communication open with your doctor and report any new symptoms as soon as they arise to prevent potential issues from progressing.

Updated on: 10/02/17
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SpineUniverse spoke with Lali Sekhon, MD, PhD, FACS to obtain his advice about preparing for and getting the most from an appointment or consultation with a spine surgeon.
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