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CBCT
Cone Beam Computed Tomography
CBCT is an imaging modality which lets us get a 3D, 360 degree view of your anatomy at the upper neck. This is essential to making sure that we design the best possible adjustment for you.
Most people have some asymmetry in their bones when comparing the right side to the left. Your left joint may be angled at 27 degrees, but the right joint may be angled at 45 degrees. That difference from side to side will change how we adjust you.
This technology also allows us to break down your image into smaller slices, which give us a view similar to an xray, but without all the overlapping anatomy. This allows us to clearly see where those top two bones have moved, and to calculate a precise adjustment for you and your anatomy.
How do we use CBCT?
The following images are examples of what a misalignment looks like in the upper neck, as well as some special issues that we have seen, and work with, in our office.
What a C1 Misalignment looks like
The Blair technique looks at how C1 is sitting underneath the Occiput. Is it forward, backward, or perfectly in line? The right and left sides of C1 can move independently, which means, often there is more than one misalignment at this bone. These two images were from the same patient, and you can see that there are two misalignments - one on the right, and one on the left. This is easily managed in our office, and this patient responded very well (headaches disappeared, better posture, anxiety calmed down).
What a C2 misalignment looks like
C2 has its own unique movement, which means that it can misalign independently of C1. When C2 misaligns, we're looking to see where it is located in relation to C3. We look at both the right and left sides of the joint to see how this bone has moved. Just like at C1, each side can move forward, backward, or a combination of the two. Often, C2 has misaligned on both sides, especially in patients who have had significant trauma, such as a car accident, concussion, etc.
C1 Spina Bifida Occulta
Spina Bifida Occulta is when the bone fails to fuse together when it forms in the womb. You can see in this image that the Posterior Arch of C1 did not fully form on the right side. This is typically asymptomatic in most people, however, it is important to know it is there so we can design an appropriate adjustment for you.
Cervical Surgical Fusion
Many people think that a surgical fusion prevents them from receiving chiropractic care, however, there are many types of surgeries, including fusions, where we can still safely adjust using upper cervical chiropractic. This patient came in with chronic neck pain (rated as 5/10) and decreased range of motion. They now have very minor neck pain (rated as 2/10) and better range of motion.
Inability to Contact C1
Some patients have a C1 that is partially hidden by part of the occiput called the mastoid process (the rounded bone you can feel behind your ear). In this case, the entire C1 is hidden by the occiput, making it impossible to adjust C1 directly. Luckily, C2 is easily contacted and adjustable. This patient presented with chronic neck pain, scoliosis, and migraines. Today they are pain free and loving life.
Non-Union of the Anterior & Posterior Arches
The anterior arch is the front side of C1, and the posterior arch is the back side of C1. Between the age of 1-7 years old, C1 will start to ossify (turn from cartilage into bone). Occasionally, parts of this bone won't fully ossify, but will remain as cartilage. The two small gaps you see in this image are an instance of this. Again, this is not something that prevents treatment, but it is something that is good to be aware of before starting care. This patient was suffering with moderate to severe tinnitus in both ears. Now they have very short (a few seconds), rare instances of tinnitus, but the constant ringing is gone!