Which is a huge part of why I chose Bolognese for my styloidectomies: he has the ability to peel the next layer and understands more of the whole ‘onion’ of my neck and cervical spine.
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thank you for your insight, I really appreciate it! it seems like that is the route I will go. One thing that holds me up is that Dr. Centeno always says that if one is going to try his PICL procedure, it’s best to do it before Eagle’s surgery rather than after, and the percentage of help from the PICL goes down after the styloids are out. This kind of opinion and information makes decisions really hard. I think for me there are different opinions in the mix and really makes it hard for the patient to make a sound decsion.
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@GiannaM - Did Dr. Centeno give you a reason he thinks PICL doesn’t work as well after a styloidectomy? I find that opinion interesting though I don’t know much about the mechanism by which PICL works.
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Hi! Here are some of his short videos explaining his opinion on this. Now this is not the opinion that most ES surgeons have. So we have to take it with a grain of salt. For those with ES and CCI I think different opinions like this really make use confused …
I think for some of use that contemplate ES surgery and PICL to try to avoid fusions these different opinions get tricky
https://youtube.com/shorts/PjiFb0GVAUY?si=rH2g0rNp1u-abehW
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@GiannaM - I watched all 3 videos you linked & strongly disagree w/ Dr. Centeno on most of the points he made.
1st video - ES diagnoses are not 'pulled out of thin air" as he suggests. They are the product of a doctor learning about a patient’s symptoms, referral for a diagnostic CT scan, & revelation of one or both styloids being elongated &/or stylohyoid ligaments being calcified, with the existing symptoms being known to be caused by ES. Some doctors who are familiar with ES know the multitudinous symptoms it can cause whereas others confine ES to only a few specific symptoms & thus under diagnose it. I suggest that Dr. Centeno is in the latter category. I’d also like to know on what evidence he bases the statistic he gives that it’s 20x more likely the symptoms present when a styloid is elongated are not related to the styloid elongation. He goes on to suggest getting specific testing for other possible symptoms causes which quite a number of our members have done only to come back to the fact their symptoms are likely caused by their styloids.
If you haven’t read the list of symptoms ES can cause which @Jules put together plus her post about the styloids which she backs up w/ links to medical research papers in many cases, they will be enlightening for you:
The only cranial nerve Dr. Centeno mentions as being a cause of ES symptoms is CN IX - the glossopharyngeal nerve. He also only mentioned ES as causing neck pain. We have documented evidence that an elongated styloid is able to irritate 5, & potentially 6, other cranial nerves i.e. CN V - Trigeminal, CN VII - Facial, X - Vagus, XI - Spinal Accessory, XII - Hypoglossal, & possibly VIII - Vestibulocochlear. He also mentioned internal jugular vein compression somewhat lightly (3rd video) but failed to mention carotid artery compression which can cause a stroke.
2nd video - Having a styloidectomy has NOT been consistently demonstrated to make CCI worse. In fact, there are a number of other doctors who argue that the styloids play no role in cervical spine stability. The spine is firmly supported & stabilized by many small & larger muscles, tendons, ligaments, & fascia so instability can be a function of muscle weakness brought on by poor posture, injury, or disease (EDS for example), & an elongated styloid is thus not a supportive structure that stabilizes an unstable cervical spine. It’s more of an adaptive response on the body’s part for what it detects as instability. However, that adaptation i.e. styloid elongation/stylohyoid ligament calcification ends up causing more problems than it helps. In many cases, as the styloid(s)/calcified s-h ligament(s) grow, they bump up against, or can tangle with, the cranial nerves & critical vascular tissues I’ve listed above.
Normally a person doesn’t experience irritation of all 7 of the suggested nerves. Most frequently there is irritation of the trigeminal, facial, glossopharyngeal, vagus & spinal accessory nerves. These nerves cause diverse & far reaching pain or other uncomfy symptoms w/in the body which can worsen in different head positions as the styloid(s) increase pressure on them. That is not to say that CCI can’t also cause similar symptoms to ES, but in light of the fact we have so few members who’ve benefitted from alternative therapies such as prolotherapy, PICL, & stem cell injections, & later had styloidectomies which were beneficial, I suggest that styloidectomies are potentially the more reliable solution to the symptoms.
3rd video - Dr. Centeno asserts the fact that when a person has IJV stenosis on imaging it “doesn’t mean much”. The question he was answering was asked by a person w/ <50% IJV stenosis who did have symptoms we know via medical research can be caused by that stenosis & ES, so I question why he’d comment up front that it doesn’t mean much on imaging. Agreed there are people who have stenotic IJVs that are asymptomatic, but people who find their way to our forum & to Dr. Centeno are desperate to understand the cause(s) of their “crazy” (as he put it) symptoms thus are not asymptomatic. Whether caused by CCI or elongated styloids/calcified s-h ligaments, IJV stenosis on imaging is significant, not insignificant as he suggests. Additionally in answering the person’s question he suggests that standard ES only causes tinnitus & back of the throat pain (caused by CN IX) & not neck pain which is ABSOLUTELY wrong! Many of our members have neck pain from ES that has nothing to do w/ CCI.
I don’t know whether what I’ve said will further “muddy the waters” for you, but I hope it gives you a new perspective based on my experience on this forum for the last 11 years.
I believe CCI can cause IJV compression, but in my experience here, it also possibly causes styloid elongation which causes symptoms that only a styloidectomy can resolve.
Dr. Centeno further said that once the styloid is removed it’s harder to for the his procedures to help reduce cervical instability because he suggests that the styloid has played a key role in helping keep the cervical spine stable, & once it’s gone, the support it provided is no longer there. He also said that when CCI is successfully treated the symptoms which had been blamed on an elongated styloid go away so a styloidectomy is no longer necessary.
I profoundly disagree w/ those statements as we have had members over the years who’ve had elongated styloids & CCI. Preliminary alternative therapy for CCI has cost them thousands of dollars & provided no results, but upon learning of their ES diagnosis, & then having styloidectomy surgery, the symptoms reduced or fully disappeared. That’s not to say the CCI & ES don’t have symptoms in common, but ES can cause neck pain, & other symptoms that he also associates with CCI.
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Thanks for all that info about the videos @Isaiah_40_31 , I haven’t had time to watch them!
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So well said !! Thank you for sharing and from my research what you’ve said has been proven with many successful ES surgeries. I just wanted to show you some of his content which can make patients very confused because his personal opinions and ES surgeon opinions contradict eachother so much. It’s all very interesting and no wonder people dealing with multiple head and neck issues can have such a hard time determining their next step. I really appreciate this group and its members!
I’m praying I can soon make a decision that I can trust in, as this limbo has gone on for me way too long !
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So true. Particularly when there is a non-surgical option. So many of us are reluctant to be sliced into if we don’t have to do that.
This is also such a common story. I do not doubt Dr Centano’s sincerity, and I know some people have had miraculous results with symptoms alleviation, no matter what was thought to be the source prior to treatment. But for so many, Centano-Schultz seems to be an expensive way-station on the road to surgery.
Good luck @GiannaM. You will find the right thing to do. You have invasive testing with Dr B next month, right? I hope that will shed some insightful light on your situation if you have not already decided.
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thank you for the well wishes in determining my next step. In Dec 2024 dr constantio diagnosed with with ES with some IJV compression. I was in the waiting period to get my opinion letter from Dr.B and got that in june 2025. In sept 2025 I did ICT (they aborted ICP that day bc was having a rare good day). I could not tolerate ict that day, I had some issues being very uncomfortable in the rest of my body with not being able to like keep my butt on the OR table, so I only lasted 15 minutes in traction. I felt like I was being stretch too much or something. Ironically, I had the best 2 weeks of my life pain wise leading up to ICT so it was inconclusive. I had some improvement but had major rebound afterwards, which has scared me from repeating ICT like Dr. B wants me to. In addition to getting his opinion on my cci I was looking for him to give me a second opinion/surgical green light for styloidectomy. At this time he wants me to do ICP so I may go on april 17 for that. I did an invasive angiogram/venogram with his interventional radiologist in September 2025 too. So I am either going to do the icp in april or just go with surgery with dr. constantino. If i need fusion In the future, I figured doing everything with Dr. B would be beneficial. I have a bad quality of life and am constantly in pain neck, shoulder, head, face and NUCCA is not cutting it anymore. I cant keep living like this so part of me thinks I should just try ICT again but I am apprehensive due the that strong rebound the first time and increase of mouth and face pain. Its all so confusing! Dr. Jenkins recommended C0-2 fusion and multilevel laminoplasty. Dr. Henderson said no significant cci (which I cant agree with since I am so disabled by all this) , Dr. B is currently inconclusive. I still have PICL in the back of my mind thinking if I dont try this before any fusion, I just dont want to have any regrets, though I dont have the funds right now. Sorry for the long reply and thanks for listening
@GiannaM -
I feel a bit silly for asking, but what is ICT? I know ICP refers to intracranial pressure. You referred to having had traction in the quote above. Does that stand for cervical traction? When you said they aborted ICP bc you were having a good day, does that mean your intracranial pressure wasn’t measured that day or does ICP refer to something else in that context? If it was pressure measurement, how are you getting that done? I only know of ICP being measured via a catheter angio/venogram.
I’m so sorry for all the confusion your research has caused you instead of helping your path to the best treatment be straight forward. As you’ve noted, at some point you’ll choose one of the options you’ve been given & will run with it. Once you’ve recovered from whatever that option was, based on whatever symptoms are left, you can then choose your next step. Our members who have complex cases usually don’t have a “one & done” experience with treatment, but each subsequent treatment/therapy is a stepping stone toward becoming more well & more pain free. Recovery can be quite the process, but we’re here for you along your whole journey. Please know we’re always here to support you. 
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Hi! Not silly at all! Yes ICT is invasive cervical traction. Unlike most surgeons this is what Dr b uses to justify a cci fusion in addition to symptoms and imaging. And the icp he does is an intercranial pressure bolt. It is inserted in the top right portion of the head and stays there to measure the pressure in the skull while in different positions. It can last several hours if necessary. The interventional radiologist who did my invasive catheter angiogram/ venogram told me the difference between the two is that the angiogram/ venogram procedure measures pressure in the blood vessels and the ICP bolt measures pressure in the skull or head I forget which. I know Dr b uses this for his work up . Dr b is the one who sent me to get my angiogram venogram procedure too.
Thank you so much for the support I really appreciate it. Do you know how long people usually take to recover from styloidectomy ? I know when c1 process is shaved lr removed it seems to take longer
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Thank you for the explanations, @GiannaM! I’d forgotten about the bolt procedure though it’s been mentioned on here before. I don’t remember reading about the invasive cervical traction though. What a lot you’ve been through! You’re doing such a great job of “leaving no stone unturned” as you work your way toward which way to go first with your treatment. I hope at some point you simply have a sense of what should come first.
My ES recoveries were both different. My first surgery took longer because I had a nerve wrapped around my styloid. My first recovery was also slower, possibly because of the nerve being moved off my styloid, or maybe because it was a more difficult surgery. I felt pretty sore & out of it the first week after surgery, but by the second week after I started feeling little bits of improvement. By a month post op things were much more improved. It took 2 months post op for my energy to return. It did take close to a year for some of my symptoms to gradually fade away but by 6 months post op I felt pretty doggone good. Unfortunately, the symptoms my other styloid were causing began to get worse about 2 months after my first surgery so even though my first side was much better, I was still battling symptoms. The second styloidectomy was much more straighforward & even the first post op week was easier & I felt much more back to my old self by 6 weeks post op. Again, there were symptoms that stuck around but gradually faded over a number of months post op.
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thank you for the well wishes in determining my next step. In Dec 2024 dr constantio diagnosed with with ES with some IJV compression. I was in the waiting period to get my opinion letter from Dr.B and got that in june 2025. In sept 2025 I did ICT (they aborted ICP that day bc was having a rare good day). I could not tolerate ict that day, I had some issues being very uncomfortable in the rest of my body with not being able to like keep my butt on the OR table, so I only lasted 15 minutes in traction. I felt like I was being stretch too much or something. Ironically, I had the best 2 weeks of my life pain wise leading up to ICT so it was inconclusive. I had some improvement but had major rebound afterwards, which has scared me from repeating ICT like Dr. B wants me to. In addition to getting his opinion on my cci I was looking for him to give me a second opinion/surgical green light for styloidectomy. At this time he wants me to do ICP so I may go on april 17 for that. I did an invasive angiogram/venogram with his interventional radiologist in September 2025 too. So I am either going to do the icp in april or just go with surgery with dr. constantino. If i need fusion In the future, I figured doing everything with Dr. B would be beneficial. I have a bad quality of life and am constantly in pain neck, shoulder, head, face and NUCCA is not cutting it anymore. I cant keep living like this so part of me thinks I should just try ICT again but I am apprehensive due the that strong rebound the first time and increase of mouth and face pain. Its all so confusing! Dr. Jenkins recommended C0-2 fusion and multilevel laminoplasty. Dr. Henderson said no significant cci (which I cant agree with since I am so disabled by all this) , Dr. B is currently inconclusive. I still have PICL in the back of my mind thinking if I dont try this before any fusion, I just dont want to have any regrets, though I dont have the funds right now. Sorry for the long reply and thanks for listening
Just for reference and hopefully to add to your clarity (not your uncertainty!): my ICT ruled out a fusion, which was super helpful in terms of making plans for intervention. This might change in the future, but after that testing, I was able to focus on the styloidectomies, which Dr B recommended, along with the possibility of a C1 resection. In addition, my ICP showed low pressure, not high as expected. Because of my manometry with the IR, we knew I had high pressure issues, so the low pressures on ICP meant going to look for leaks, which were subsequently found. I think I shared this with you before @GiannaM , but the thoroughness of Dr B’s testing really helped me a lot in terms of understanding what was actually going on and therefore, what might be reasonable interventions. For complex patients this is so important. And what was found was not what was anticipated. So….if Dr Henderson had evaluated my imaging and looked at my clinical picture, I am pretty sure he would have offered fusion. I really can’t afford (on all levels) to be treating things that are not the source of my problems, if I can help it. I know you are afraid of the ICT rebound, and I get it. Some of us are so sick that the prospect of pulling ourselves together to travel somewhere and all that entails only to make ourselves sicker yet seems unfathomable. But it sounds like you are declining and your quality of life is really low right now. For which I am so sorry.
I also know a couple people who have had multiple ICTs–as I think you do as well-and for whom the outcomes changed. What was a ‘no’ to fusion became a ‘first thing tomorrow morning.’ Some of it, I think, reflects changes in anatomy over time, but there are such variants in how we ‘do’ the ICT. How much we guard or how we feel on the day. Has anyone looked at tethered cord for you? I am struck by your inability to keep your butt on the OR table while having ICT. I am sure this has been considered.
I will conclude by saying that for me, with all the possible interventions on the table, styloid removal really seemed like the best first step. It is relatively low risk, requires less recovery than some of the other treatment options (like fusion or even decompression) and was what Dr B recommended. I hope you can find your best next step soon, and go for it.
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I can’t really offer any opinion on your testing & which path you take, the testing sounds incredibly invasive & horrible, and I would’ve said is it worth putting yourself through all that, but @jyoti 's experience shows that covering everything before deciding is worth it… Not an easy choice when you have so much going on, more hugs and prayers 
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I know @GiannaM and I have been discussing tests and treatments outside the scope of this forum but for some of us ES is tangled up in a bigger mess. Teasing apart the various pathologies is often incredibly challenging and it is so helpful to be able to learn and share and ask about one of them here.
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@jyoti - We totally understand the need for & respect the types of discussions that intermingle diagnostic measures/treatments for things that exist adjacent to ES in more complex cases. I for one am grateful for what I learn from the type of discussion you & @GiannaM are having in this discussion thread. 
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I’m glad that you’re supporting each other on this difficult journey, it helps when others are going through the same things
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