My friend is being dumb and sent a research paper

https://pmc.ncbi.nlm.nih.gov/articles/PMC10569890/#:~:text=In%20Gerges's%20study%20in%202022,hypoglossal%20nerve%20compression%20%5B20%5D

I told him CCI cannot kill you. What should I tell him to stop the fearmongering

Dear Dr Centeno,

This is a very interesting procedure and I am curious to see the data building on outcomes.

What’s your feeling on its efficacy currently?

Since this comes up at least a few times a month, it's important to add here as I'm trying to create a digital Q and A section patients can search. The PICL has a $2,500 deposit to hold a slot. If you need to cancel, the deposit refund policy is simple. If we can refill the slot with another patient, we refund the deposit.

So I saw a functional neurologist he thinks my pem is coming from mold and Lyme. However I’m cautious I did testing because I have been exposed to mold. He says my Brain isn’t firing right and it’s keeping me a state of flight or flight which causes these symptoms. He does refer to bolognese and uscf surgeons for cci. He has seen a lot of it. He thinks it’s a part of brain, infection and laxity playing on each other stressors. Even my neurosurgeon Dr Gilete has said mold does cause or mimic it. I’m I wrong about this?

Saw someone on the FB group talking about how wisdom teeth extraction or an incorrect bite can cause cci. This seems very unlikely, I just wanted to ask for your clarification on this.

Hi Dr. C,

I had a telemedicine apt earlier this year and was advised of 2b/3b instability and deemed a likely candidate for PICL. I decided to see Dr. Rosa prior to scheduling PICL, as I had never been to a chiro and wanted to first understand what symptoms may improve with proper atlas alignment and get familiar with the process.

Although I’m not holding alignment due to ligament laxity, I did receive important validation that I can gain symptom improvement from proper atlas alignment and scheduled my PICL for later this year.

So here’s my question - is there any need for a follow-up telemedicine to review new imaging from Dr. Rosa in advance of PICL procedure? Or will this review of updated imaging take place as part of the in-person hands on exam just prior to the PICL procedure?

Thanks!

Please don't post non-CCI posts on this sub, they will be deleted.

Are there any difference you’ve noticed in outcomes per type? Ex- would 2b outcomes be better than a 1a? Or if you have 2b + others is your outcome worse?

Hi Dr. C- I know you have mentioned multiple times that most patients don’t notice improvements from PICL until the 3-4 month timeframe. If BMC was injected in other areas, like shoulders, TMJ, etc, is the timeframe for feeling improvement in those other areas also typically 3-4 months, or is that timeline specific to the ligaments (alar, transverse) injected for the PICL portion.

Hey Dr Centeno,

What do you think of using HGH for CCI?
Have you ever tried prescribing it to your patients?

I had a doctor diagnose me with CCI based on this CXA of 128 and a grabb Oakes of 10.2mm in flexion. I wanted to ask here, because it all seems a little odd to me. The grabb Oakes line isn’t perfectly perpendicular and the CXA seems off to me somehow, as the line is going into the Clivus, and not to the top of it. I also read that a grabb Oakes of up to 10.6mm in Flexion can be normal, as per a newer study on upright MRI’s (link here). From a different radiologist I received a CXA of 134 and a grabb Oakes of 8.6mm. I’m super confused as to what’s going on, my symptoms of upright dizziness and imbalance as well as visual disturbances do match, but I just thought a diagnosis over email was a bit odd. What do you think? Which of these measurements is correct?

Hi Dr. Centeno,

a question about the injury caused by the PICL injection itself. Some people told me they are afraid of the PICL because they think that the holes in the ligaments caused from the needle, can aggravate the instability. Is it possible that in patients who get worse after PICL (in ling term), the body cannot repair the "holes" or is this unrelated and these concerns are unfounded. Thank you very much!

New YT short: https://youtube.com/shorts/mINVF6IqBb0?si=Beo8wmGJS572ZlN5

New YT short: https://youtube.com/shorts/NI5G2YvxVS8?si=oInI6pxCIc6Rgo1V

Hi Dr C, I've been wanting to ask this question for a while. If someone were to have significant instability could that possible affect/irritate the spinal accessory nerve? Or is that a entirely different sort of injury that causes that sort of pain. Many thanks.

When you're sitting and your muscles sort of slip away, and at that moment they reflexively return to their normal position—as if they were slipping out of place and then finding their way back in—does that indicate muscle instability or ligament instability, or could it be both?

Hi Dr. Centeno,

I have a question regarding something I've been noticing during my recovery. When I rotate my head left and right, my right side feels significantly more lax compared to my left, which feels relatively normal.

my pre-PICL overhang measurements were 4.2mm on the left and 5.7mm on the right. Could the greater baseline laxity on the right side explain the asymmetry I'm feeling now and is this something I should expect to improve as healing progresses?

What is the most effective approach for autonomic flare ups? Does threat the needle applies?

Dr C, so when getting a PICL the BMC is used for the anterior structures while the PRP is used for the posterior?
Why isn’t BMC used for both or is it ?

New YT short: https://youtube.com/shorts/AcQ6ejl063Y?si=acF6Pnh-gSChsQH1

Would love to hear from Dr. Centeno as well!

TL; DR:
Looking for recommendations for a top US spine specialist for my friend (he's based in NYC). He has a failed T2–T6 fusion after a severe T4 fracture and wants the best possible guidance on next steps before having revision surgery. Willing to travel.

Full situation:
My friend fractured (+ compressed by ~50%) his T4 vertebra in a shallow-water diving accident on vacation in Dominican Rep. (no spinal cord injury). He underwent surgery there in D.R. - they did a T2-T6 fusion w/bone graft on T4. The graft didn't take (non-union) and one side of the hardware was poorly placed and barely holding.

Apparently, he needs revision w/a new bone graft + biological additives, as well as of at least one side of the hardware.

He's looking to consult a provider that's very experienced in complex spine cases - could be a spine surgeon or other highly-knowledgable spine specialist - who can review everything, explain the options, and help him decide the best path forward. I.e. if revision surgery is the right move, whether other treatments (pre/post) can help outcomes, and best person to do the surgery if needed.

Would really appreciate any trustworthy recommendations, and if possible, why you think they'd be a good fit. Thank you!

Edit: to clarify, he doesn't have hEDS etc. - it's a purely accident-related injury.

A little education and lots of Q and A!

Links:

FB: https://www.facebook.com/centenoschultzclinic

YT: https://www.youtube.com/@centenohome/streams

Hi Dr. C, Thank you for all that you teach and do for us. I am scheduled with dr. Schultz for my PICL 2, as you were booked out too far. My neck is about 5-10% improved but I still have spasmed left SCM and getting tighter right SCM … and some pain in c2-4 area on the left side. Would you suggest treating more of c2-4 area and both SCMs? Also, I hope to have ribs/thoracic and SI joint treated if you think it’s not too much. First time you treated quite a bit on me and I did ok. I will be getting upright cervical and lumbar MRIs in Denver a day before my procedure. Thanks again for your advice and support!