Virtual Visits Available / 303-429-6448 Text Us Make an Appointment MENU The CCJ Instability Institute HOME OF THE PICL – THE TRUSTED NON-SURGICAL CRANIOCERVICAL INSTABILITY TREATMENT About the CCJ Instability Institute There are strong ligaments that hold your head on, and these can be traumatically injured or otherwise become loose due to connective tissue disorders. At the CCJ Instability Institute, helping your body heal these ligaments is what we do. While these patients of craniocervical instability often get very dangerous and invasive surgery, we have developed a non-surgical, injection-based approach that uses your own bone marrow concentrate, carefully delivered into the alar, transverse, and accessory ligaments using our one of a kind PICL (Percutaneous Implantation of the CCJ Ligaments), the trusted non-surgical craniocervical instability treatment. The CCJ Instability Institute is currently located at the Centeno-Schultz Clinic which serves as the International HQ for the Regenexx network. Am I a Candidate? JUMP TO COMMON SYMPTOMS PICL PROCEDURE (OVERVIEW) TREATMENT OPTIONS RECOMMENDED READING OUR RESEARCH DOWNLOAD CCI 101 What is Craniocervical Instability (CCI)? Craniocervical instability is a medical condition with numerous names, including cranio-cervical instability (CCI), cranial instability, cranio-cervical syndrome, occipitoatlantialaxial hypermobility, the Syndrome of Barre Lieou, upper cervical instability, atlantoaxial instability, and others. The head is held onto the neck with strong ligaments. When these ligaments are injured or damaged or just loose due to congenital problems (like Ehler-Danlos Syndrome which can cause stretchy ligaments), the head can become unstable on the upper neck. This is called CCJ instability. This extra motion can lead to many different issues. These include early onset arthritis in the upper neck joints. This can cause local pain in the upper neck, as well as headaches and/or dizziness and other symptoms due to spinal cord compression. In addition, the natural position sense provided by this part of the neck can become abnormal, causing other parts of the body to become misaligned and painful. Finally, there are many muscles that have tendons that can be beat up over time, leading to tendinopathy and pain. Common symptoms of CCI We see many different craniocervical instability symptoms, but the more common ones are: Headaches (with the sensation that your head feels too heavy) Dizziness or imbalance Visual changes Neck pain Numbness and tingling Rapid heart rate Feeling spacey or disoriented Fatique Muscle weakness Watch Dr. Schultz’s video on the most common symptoms of CCI Recommended Reading Understanding CCI Measurements vs. Instability (CCI Series, Episode 1) What Goes into the PICL Procedure for CCI? (CCI Series, Episode 2) C1-C2 Fusion – Complications are Common (CCI Series, Episode 3) A New Ligament is Rediscovered (CCI Series, Episode 4) Post-PICL Rehab (CCI Series, Episode 5) Understanding Common Injections for CCI Patients (CCI Series, Episode 6) Ehlers Danlos Syndrome & Craniocervical Instability: What to Know! Do I have Cervical Medullary Syndrome? 7 Criteria for Diagnosing Craniocervical Instability Your Craniocervical Instability Treatment Options Physical therapy to strengthen the upper neck muscles. This is very specific therapy that few physical therapists understand. Curve restoration. This is a specific type of therapy that uses front-back traction to increase the curve of the neck and offload the upper cervical spine. Upper cervical chiropractic. This is specific adjustments to restore normal alignment of the upper neck. Prolotherapy – This is an injection of substances that cause a brief inflammatory reaction that can cause ligaments to tighten or get stronger. This procedure can only reach the outer ligaments of the neck and not the internal ligaments that frequently cause CCI. Platelet Rich Plasma or Bone Marrow Concentrate Injections – These procedures inject platelets and/or bone marrow concentrate that can help repair damaged ligaments, but again, this can only reach the outer ligaments of the neck and not the ligaments that frequently cause CCI. Surgical Fusion -This procedure places hardware to stabilize all or some or all of the C0-C2 segments of the neck. The problem is that adjacent segment disease is common, which means that the areas above or below the fusion get more wear and tear and arthritis. PICL Procedure-This is our non-surgical craniocervical instability treatment. This procedure involves injecting the patient’s own bone marrow concentrate directly into the craniocervical ligaments. The advantage is no surgery and the goal is to strengthen these internal ligaments that stabilize the head on the neck. The PICL Procedure The Trusted Craniocervical Instability Treatment Option The PICL (Percutaneous Implantation of the CCJ Ligaments) procedure is a highly precise, direct injection of the CCJ ligaments including the alar, transverse, and accessory ligaments for the treatment of craniocervical instability. The tectorial and PAO membranes can also be injected. The implantation part of the acronym refers to placing the patient’s own bone marrow concentrate into these ligaments to promote healing. In order to reach these ligaments, the only safe route (that avoids the upper cervical spinal cord) is through the posterior oropharynx (back of the throat). To accommodate this, the patient is put to sleep using advanced anesthesia techniques and a specialized and custom 3D printed oral appliance is used to hold the tongue down and the airway open while allowing x-ray guidance using fluoroscopy. Our CCI treatment is dramatically less invasive than upper neck fusion surgery – with fewer complications, less pain, and less recovery time. Its goal is to heal damaged ligaments rather than screwing together bones. At its heart, it’s a complex and technically demanding injection rather than an invasive open surgery. Read our Research on Regenerative Treatments for CCJ Instability Neck ligament traumatic instability with measurement of translation. Neck ligament treatment for traumatic instability with objective flexion-extension measurements. Chronic neck pain after whiplash, a case control study. Comments on upper cervical neck imaging for CCJ instability. A case control study of Chari malformation and whiplash. Comments on the imaging on alar, transverse ligaments. A new C0-C1 facet injection technique. Is the PICL Procedure Safe? We have been performing the PICL procedure since 2014. We took the adoption and development of this technique very slowly, adding advancements as we learned more. Given our experience to date, we can safely say that the procedure has produced no severe adverse events that were no easily treated. In addition, based on the published rates of complications with CCJ surgeries, the risk profile of the PICL procedure is far less than these procedures. Additional research continues and we will continue to publish our procedural results and complications. Download Your Copy of CCI 101: Understanding Craniocervical Instability and the Road to Recovery Dr. Centeno’s new book on Craniocervical Instability is now ready to go! This covers everything from conservative care to surgery to newer precise injection procedures like PICL that can help existing ligaments tighten down and stabilize the upper neck. This book is a must-read for anyone diagnosed with CCI. This is version 1 of this book and while it has been read by several CCI patient advocates who made suggestions if you find things that require correction or have ideas for improvements, please send a quick email to the author at centenooffice@centenoschultz.com! May we communicate with you by text? Yes, I'm in! Not at this time Submit