Exams and Tests to Diagnose Upper Cervical Disorders

Early diagnosis is vital to long-term health and quality of life.

It’s a common phrase in medicine: Early diagnosis produces better outcomes. This is particularly true with head and upper neck disorders (which are also known as upper cervical disorders, craniovertebral junction (CVJ) abnormalities, and craniocervical disorders). Starting treatment early can reverse or completely prevent some of the more disabling effects of these conditions.
smiling male doctor and patient talkingWhen to See Your Doctor
The signs and symptoms of upper cervical disorders can appear quickly—or they may suddenly worsen. In these cases, you should see your doctor as soon as possible.

Your doctor will review your medical history, conduct physical and neurological exams, and ask you about your symptoms. Neck pain and headache in the back of the head are the most common symptoms of a CVJ abnormality, and involuntary eye movement is a typical sign. Reviewing these signs and symptoms with your doctor is often the first step in the upper cervical disorder diagnosis process.

While your doctor may suspect a possible upper cervical disorder after the physical exam and symptom review, he or she will order imaging scans to confirm your diagnosis.

MRI and CT Scans: The Pillars of an Upper Cervical Disorder Diagnosis
Magnetic resonance imaging (MRI) and computed tomography (CT) scans are the 2 most commonly used imaging tests to confirm the presence of a CVJ abnormality. These tests show sharp images of your brain, upper spinal cord, and surrounding structures—and they can illuminate possible problems.

MRI uses a magnetic field and radio frequency pulses to produce detailed images of your internal organs, muscles, and bones—all without the use of any radiation. CT scans are ideal at showing bone, as this tool highlights bones from their surrounding soft tissues and vascular structures.

In some cases, particularly if your symptoms suddenly appeared or worsened, you may have your imaging tests the same day you visit your doctor. If MRI and CT scan aren’t available as quickly as your doctor would like, he or she may order an x-ray.

If your MRI or CT scans don’t produce conclusive results, your doctor may then order another test called myelography. In this test, your doctor injects a contrast dye and uses an imaging test (such as a CT scan) to illuminate the spaces surrounding the nerves and spinal cord. This will help your doctor understand if your spinal cord is being compressed due to an upper cervical disorder.

Angiography: Another Diagnostic Tool for Head and Upper Neck Disorders
If your MRI or CT scan shows a CVJ abnormality possibly interfering with the blood vessels in your head and upper neck, your doctor may also order an angiography, or an angiogram. This diagnostic tool provides detailed images of the vascular elements of your body—the veins, arteries, and blood vessels.

There are different types of angiography that your doctor may use. Conventional angiography uses x-rays and a special dye called radiopaque contrast to view your vascular structures. A second option is CT angiography, which uses CT technology and radiopaque dye to show your blood vessels. A third option is magnetic resonance angiography, which uses a strong magnetic field and radio waves to produce blood vessel imagery.

If a spinal tumor, such as chordoma, is the source of your CVJ abnormality, an angiogram can illuminate the spinal tumor and show the blood vessels feeding the tumor. You can learn more about angiography here.

Bone Scans: Another Test in the Diagnostic Toolbox
Bone scans are a form of nuclear imaging, and your doctor may refer to this test a radionuclide bone scan. While the term “nuclear” may make you concerned, bone scans pose no more health risks than a conventional x-ray. This test is useful for people who may not be ideal candidates for plain x-ray.

Bone scans use small amounts of radioactive materials that are present in some structures in your body, including your bones. These radioactive materials emit radiation that can be picked up by a special gamma camera that creates images.

A bone scan can help your doctor understand if you have a spinal tumor, bone infection, spinal fracture, a bone disease (such as Paget’s disease)—practically any bone problem that may be associated with a possible CVJ abnormality.

Early Diagnosis of Upper Cervical Disorders Leads to Better Outcomes
If you experience sudden neck pain or headaches in the back of your head—or any of the common symptoms of upper cervical disorders—don’t hesitate to see your doctor. Your symptoms may be indicative of a head or upper neck disorder that could cause serious problems if not treated. Fortunately, numerous treatments—both non-surgical and surgical—may lead to long-term success when used early in the disease’s progression. You can learn more about your therapeutic options in Non-Surgical Treatments for Upper Cervical Disorders and Spine Surgery for Upper Cervical Disorders.

Updated on: 10/02/17
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