I had the 3-D CT scan with contrast-bilateral elongated and calcified 4.5 cm now Dr Nakaji wanted my ENT here to order a CTV
I would’ve posted pictures from my CT earlier but I cannot get the disk to work these images that I have are not great because I’m just taking a picture with my phone… I took a bunch.
@Minh2025 - I’m sorry your disc isn’t being cooperative. The pictures you shared are pretty good & do show that your left IJV is being compressed more by C1 than by your styloid.
Besides just seeing the compression, Dr. Nakaji will also test for the rate of blood blow through the IJVs to determine if he feels the compression is bad enough to warrant decompression surgery. Unfortunately, he seems to consider the flow rate or pressure at various places in the vein above the symptoms a patient has. I feel both play a role in the ultimate decision as to whether decompression surgery is warranted, but I’m not a doctor.
As she played it I just snapped pictures with my phone and I’m even kind of at an angle so I know it’s not a great shot- I also don’t know what tells the most so I’m just posting these to see if they say anything about whats going on
Have you tried uploading radiantviewer.com (for PCs) or Bee Dicom Viewer (for Macs) & loading your images into one of those programs? They will convert the images to 3D & make it easier for you to see what’s going on.
Also just letting you know that I am interviewing Dr Nakaji but I also have an appointment with Dr. Osborne in LA and Babu Welch in Fort Worth.. this is too important not to meet with a few people. these will be phone consultations…
I don’t have that but my friend does I will try it…
I’m glad you’re being thorough. It’s important to be well informed & also to choose a doctor who’s personality you get along with & who’s surgical approach seems best to you. You will likely get some differing opinions along the way. We may be able to help you sort those out if they’re confusing.
Thank you so much I feel so grateful to have found this forum… Honestly I would be freaking out if I didn’t have it because it’s overwhelming to make all these decisions
So I had Atlas orthogonal which is a C1 adjustment June 2 I have held the adjustment and the fluid that was building up from the cerebral spinal fluid moved better after… If the C1 is compressing the jugular I’m wondering if it’s worse because I did the adjustment? What do you think? I know some of my symptoms have exaggerated since I did the Atlas adjustment but I had a forward curve and now it’s much better… There are so many moving parts with this…
I also had fluid buildup on my eyes and having the atlas done seem to help with that and I’m able to see better… Hope I didn’t make a mistake doing that adjustment
Atlas adjust ment results seem to be mixed among our members. Some have had great results & some symptoms resolution like you, but some ES symptoms remain. For others, they’ve made symptoms worse. I don’t know if it depends on the technique use, the doctor doing the adjustments, what the actual problems are that are causing symptoms, or a some combination of those.
I’m guessing if your adjustment is holding, then it isn’t suddenly causing compression, but if you had compression before the adjustment it may not have helped stop it.
@Minh2025 these are decent views, but not definitive in the role of the styloids. It can be hard to tell from the sagittal view (i.e., the side view that you have posted) how much IJV compression is being caused by C1 vs how much is being caused by the styloids. You do have IJV compression though, just can’t tell from this angle which structure(s) are to blame.
The best view is the axial view of C1. Here’s my own to show you what it looks like. It’s the top vertebrae with a white circle in the top middle:
I’ll see tomorrow if I can download all of it based on y’all’s instructions… I know this picture isnt just like yours… But it’s just another one that I have so I thought I would put it out there.
@Minh2025 see attached annotated imaging.
Both your IJVs are compressed against the wings of your C1 tranverse process.Your styloids aren’t causing any compression (at least at this specific slice). C1 shave on both sides could help open the IJVs up. We’ll have to see a 3D reconstruction to see the full lengths of your stylohyoid ligaments.
Your left ICA is pushed up against your left IJV which I don’t see often. Not sure if this is contributing anything or not. I’d say stay away from atlas adjustments. Any temporary loosening or shifting of C1/C2 could cause temporary flare ups of your symptoms. Your vagus nerves may be compressed between your IJVs and C1 as well.
Dr Nakaji will see all of the images on Monday… Thanks for looking over this, I was having a lot of symptoms before I did the Atlas June 2… that’s why I tried it. Cerebral spinal fluid moves better and I can see better out of my left eye- but definitely the pain in the neck is worse… My styloid’s were only 4.5 cm so not as bad as some on here… But I am wondering if styloids caused my jaw to be off that happened during Covid and nobody knows why.
I will let you know what the doctor says after he reviews my images…
Is shaving your C1 easier than removing the styloids?
@Minh2025 4.5cm styloid can definitely cause issues. Jaw, throat, neck, ear, eye symptoms. Glad Dr. Nakaji is taking a look.
Styloidectomies and c1 shaves are both major surgeries, so I can’t really judge which is “easier”. Both surgeries can be easy if the surgeon is experienced. Both have their own risks which you should discuss with the surgeon(s)
Dr Osborne doesn’t do C1 shaves, & it certainly looks like yours is playing quite a big role in the compression, obviously we can’t say for sure but it does look like just a styloidectomy might not be enough to ease the compression…
We don’t know a huge amount about Dr Welch, just that he’s recently done a styloidectomy & C1 shave for a member, so can’t say anything more about him, it’ll be interesting to hear how you find him…
I wouldn’t feel bad about the adjustment you had; if that’s helped the CSF flow & taken some of the pressure off of the eye, then that’s good…
Your styloids are pretty long, there’s no ‘just’ about 4.5 cms!!
Thanks for saying that- my appointment is at the end of the month for a Tele visit with Dr. Welch… and then I’m corresponding back-and-forth with Dr Nakaji’s office. So it looks like it’s down to those two.
A question I have -I did the Atlas adjustment and he told me from time to time I’ll have to do it again because it will go out -what happems when you do a shave on something that might move later? Also, if we find out that it’s worse on the compression after the adjustment then do we want it to move out of place and stay out?
There’s so many moving parts.. man I’m glad you guys are here. Thank you
@Minh2025 I don’thave experience with atlas adjustments, but I suspect these adjustments require the chiro (or whoever else would be qualified) to grab a hold of the sides of the atlas to move it by hand. With a C1 shave, the wings (sides) of the C1 transverse process are often shaved off. This would likely make it difficult for someone to adjust the atlas afterwards because it would be difficult to grab onto, and now there would be IJVs most likely in place where the wings used to be. This is just me thinking things intuitively.
@Minh2025 - We’ve had members who didn’t need their atlases adjusted once their styloids were removed, so there is a chance that will be the scenario for you, too.
