@Val7426 - Your husband’s cervical vertebrae are very straight. He’s lost his cervical lordotic curve. We see this very often in people who have ES. Losing the cervical curve is indicative of poor posture which can be the result of years of looking down at a computer screen, cell phone, books, etc. It can also be indicative of forward head posture which means the head isn’t centered over the shoulders but sits slightly in front of them (see the image on the left in the video link @JugularEagle posted) which puts stress on the shoulders & upper back & causes the shoulders to roll forward a bit also causing weakening of the chest muscles. This is called upper cross syndrome which in turn can lead to lower cross syndrome. There is a lot about these on YouTube including exercises to help recover from them. There are simple exercises to help restore the lordotic curve in the neck as well though it takes some time. A straight neck potentially puts the styloids in closer proximity to the nerves & vascular tissues in their local area. @vdm put together a couple of very informative discussions covering this & other topics:
Your husband’s styloids are significantly long & do appear to be squashing his IJVs against the transverse processes of his C1 vertebra. Re: your question:
Often a C1 shave isn’t necessary once the styloid(s) is/are removed, however, sometimes the IJV(s) don’t reopen when the pressure from the styloid is removed as the pressure from the TP of C1 is still significant enough to keep the IJV pinched. Another scenario is the styloid is compressing the IJV close enough to the skull base that the surgeon isn’t willing to cut the sytloid back that far due to the risk of facial or other nerve injury so the answer is to shave a little off C1 to make more space for the IJV to reopen. Dr. Hepworth used to move the IJV away from C1 a bit vs shaving it, but it seems more often now, he shaves C1.
We have one doctor in the US who does bilateral ES surgeries routinely - Dr. Hackman in Chapel Hill, NC, however, he doesn’t specifically do IJV decompression surgery. If the IJV decompresses when the styloid is removed then it does. If it doesn’t then the patient will have to see a surgeon who does IJV decompression for another round of surgeries later. Dr. Hackman is also quite pricy even for cash paying patients. Dr. Cognetti who @Jules mentioned has started doing IJV decompression surgeries w/ Dr. Heller, but I believe all of those surgeries include a C1 shave. Dr. Cognetti’s fee for international patients is around $8K, however, Dr. Heller’s fee is higher so the combined cost is fairly expensive. Also Dr. Cognetti traditionally only does unilateral surgery so your husband would have to come twice.