C1 shave- Lateral Altanto Occipital Ligament

[Kay0531]

In c1 shave of the TP- does the LAOL ligament get cut off as well? Asking as this adds to the stability from c0/c1

[PatientD]

Hi, I do not believe ligaments are affected in C1 trim. D

[Isaiah_40_31]

Actually, that’s a great question, @Ashks! I agree w/ @PatientD. The transverse process of C-1 is left as intact as possible i.e. as little bone as possible is removed to make space for the IJV. I suppose in extreme cases, more has to be removed, but the atlanto-occipital lateral ligament is left intact which is most likely why doctors who do C-1 shaves don’t think it impacts cervical stability.

[Kay0531]

Does this look like the full transverse process was cut off (post images) ?

[Isaiah_40_31]

It does look like the whole tp is gone, but it looks like there’s still enough of C-1 left to support the a-o lateral ligament. Are you have trouble w/ possible CCI symptoms i.e. is that your concern?

[Kay0531]

Yeh I have bad AAI and my skull slips back on the c1 condyle (instability there as well) only on the right side where i had the c1 shave. I was told that ligaments helps to support the slippage of the condyle so very nervous if this ligament was impacted.

[Isaiah_40_31]

Your surgeon should be able to answer that question. He should have left it intact especially if he knows you have AAI. I will say, we’ve had members w/ CCI/AAI who haven’t noticed a difference when C-1 was shaved & others who have noted their instability symptoms got worse. It’s such a tough situation for you who have both cervical instability & IJV compression because you can’t know which symptoms are worse - those from the CCI/AAI or from the IJV compression. It may also be like comparing apples to oranges, where both are terrible but in different ways so eliminating one is slightly helpful, but if it exacerbates the other, then what’s the benefit? I’m sorry for your pain & suffering. @Kay0531, you’re still early in your recovery from surgery so there is a good chance you’ll get improvement, & the severity of the current situation is temporary.

[Kay0531]

Thanks ill wait and monitor

[lilwider]

Wow your atlas is out! Do you have transverse or alar ligament damage? How long ago did you have your eagles surgery? Who did the operation? Maybe in time you could start strengthening exercises starting with isometrics to hopefully coax that c1 into a better position?

[Kay0531]

Alar ligament, laxity at c0-c1- fell on neck/ hypermobile. Had it 2 weeks ago. I was told had to wait 6 weeks for physio. Really concerned though if the muscles attached to c1 where chomped off.

[lilwider]

That is an unfortunate thing so soon after surgery. Think positive, take it easy and hopefully the inflammation will go down and help correct things. I have heard many stories here that after surgery when the inflammation goes down their cervical gets corrected. Hoping that’s the case for you

[Leah]

Was your skull slipping back prior to surgery? Or are you experiencing new problems since surgery?

I have looked at many pictures, and it is very hard to tell where the delineating line is for that ligament.

I tried to look at these two images together… And I would say it would be very close if the ligament was at all detached.

[Kay0531]

Yeh it was like that prior to the surgery. Thanks Leah. I didnt realise the shave would be so deep. Theres alot of stabilising muscles on the posterior tip of the tp as well. Probably why people with cci feel more unstable.

1. Rectus Capitis Lateralis: Has origin from superior surface, anteriorly, of transverse process of C1, and inserts into the jugular process of occipital bone.

2. Obliqus Capitis Superior Muscle: Has origin at superior surface, posteriorly of transverse process of C1, and inserts into the lateral half of the inferior nuchal line.

3. Obliqus capitis Inferioris Muscle: Originates from the apex of the spinous process of the C2 vertebra (Axis) and inserts into the posterior surface of the transverse process of C1, close to the tip.

4. Levator Scapulae Muscle: This muscle originates from the posterior tubercles of the transverse processes of C2-C4 and the lateral margin and lower border of the transverse process of C1, the atlas. It inserts into the upper part of the medial border of the scapula, and the superior angle, as discussed under “Scapula.”

5. Splenius Cervicis: This muscle originates from the spinous processes of T3-T6, and inserts into the posterior tubercles of C2 and sometimes C3, and the transverse process of C1.

6. Scalenus Medius: This muscle originates from the transverse process of C1-C6, and inserts into the upper surface of the 1st rib.

[vdm]

In the yellow area you are supposed to have a very strong alar ligament holding the odontoid in place, together with other odontoid-attached ligaments.

The alar ligament’s integrity at that side might be affected.

[Kay0531]

Thanks; yeh your spot on i have AAI alar ligament laxity. I have tried 2 x stem cell treatments with minimal improvement

[vdm]

I have lots of laxity too in that area, unfortunately… When I was younger, I could make funny looking expressions by tilting my head laterally quite a lot, and I guess in my case the styloid processes eventually got beefier to give the head extra support after a few whiplashes…

Sorry to hear the injections didn’t help…

[Kay0531]

Sorry to hear, the worst condition to endure. No that’s all good just have to push forward

[Isaiah_40_31]

Things may improve as you heal, Ashks. I hope your cervical instability isn’t too debilitating as you do recover.

[Kay0531]

Thank you, appreciate your kind words

[PatientD]

Sorry to read about CCI & Eagles. Hope you have found a medic who can advise you on CCI topics after your surgery. Hope your operation recovery continues. D