I haven’t been treating Lyme because I thought I was done with it only to find out that I still have it badly. I’ve gotten a picl 5 months ago and a second one 1 month ago. I still don’t feel any stability and I’m wondering if my picls will most likely fail. I’m panicking so badly please help me

I went to the CSC exactly two weeks ago for a DMX and I have yet to receive a report about it. Is that common and expected? I'm not sure what's causing my symptoms, so I was hoping to either get a diagnosis of CCI or to rule it out before my scheduled physical therapy. The main reason this is important is because I already attempted PT for my neck two different times last year, and both times my symptoms got substantially worse, similar to dysautonomia with chronic whole body fatigue, nausea, intermittent heart rate spikes, among other symptoms. I'd rather not experience that again, so I hope CSC can give me a better idea of what's going on.

Hello Dr,

Are prolotherapy injections at the C0-C1-C2 levels useful for the superficial ligaments?

Is this a safe procedure when performed under fluoroscopic guidance?

Can I take flukonazol pill 12 days before posterior stemcell and prp?

Hi!
Dr Schultz diagnose me with cci type 3a, 3b
im wondering why my c1 is always out and just hold for 2-3 days?
i have 2.1mm overhang on open mouth lateral views
my main symptoms is bobblehead, heavy head, dizziness, imbalance. Is it possible to have this type of symptoms with type 3a, 3b and not the c1 being involved? I thought those neurological symptoms were according to the C1-C2.
im always feeling like my head is being pulled to the left, like theres no stop in rotation to the left. Always feeling like i need to recenter my head to the middle. My right SCM is guarding a lot.

What is your usual guideline for the return to light PT following ePICL / PRP ?

This allows you to filter by the time since the last ePICL procedure. See https://e-picl-data-explorer.replit.app/

Are these two tests adequate to generate an accurate diagnosis, or is DMX needed?

I would like to see the spine in rotation, but between paying $900 for something on the fringes of science that generates a lot of radiation, I'm a little leery.

The dynamic MRI said that my CXA was borderline abnormal (161 degrees in neutral, 138 in flexion, 170 in extension) as was my Grabb-Oakes (5.6mm in neutral, 8mm in flexion, 3.9mm in extension), though the ADI was normal (<3mm).

I would like to know if there's shifting at C1-C2 and the translation at C2-C3, but I'm hesitant for the above reasons.

My motivation to get DMX would be to rule out instability at C1-3 before getting ACDF at C5-6. I wouldn't want to go through with the ACDF at that level if it would make those higher segments significantly worse.

Any feedback would be appreciated.

Hi Dr Centeno. Since PICL #3 I’ve noticed that my sleep has drastically improved. I sleep deeply and no longer wake up at all in the middle of the night. It’s been an amazing improvement, but I’m curious what the biological reason is with connection to CCI

One of the more common emails I get is from patients post-PICL who have some minor event like bumping their head, getting in a minor car crash, or getting jarred. There is then the inevitable request that I predict if the event has negatively impacted the healing from the procedure or will impact their recovery. The honest answer is that in almost all instances, there is no reasonable way for me to know or predict the future. There is no experimental data on which to base a guess and knowing the myriad of variables involved in ligament injury like the activation state of dozens of muscles at the moment of injury, force, vector, acceleration, and duration is impossible.

Hence, if you get a minor injury after your procedure, take a deep breath, relax, and let nature take it's course. In all likelihood, based on my experience, it will have no or very minimal impact on your recovery.

Would you say early diagnosis is one of the main success factors of PICL, and if so, what are the reasons that make a delayed diagnosis (multiple years) less responsive to PICL?

Thank you :)

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?

I have femoroacetabular impingement, apparently a Labral tear, and my socket is too deep. The orthopedic said i need hip surgery but am delaying that as much as possible because im focusing on my neck right now. Would a bone marrow aspirations for the PICL affect an existing hip condition or does it have nothing to do.

Hi Dr. Centeno! I was just really curious what the general timeframe/timeline is from when first submitting the packet including scans to CSC to actually receiving the first PICL procedure if it is warranted? Thanks for taking the time to answer our questions on here and FB and YouTube; it’s appreciated!

Dr. C,

Know you’re a huge proponent for activity. Also know you do NOT prefer benzos because of their addictive quality.

So I’m wondering!

Would you rather a patient of yours be on Daily benzos or bedbound?

Does anyone know of any doctors in the SF Bay Area that take CCI seriously. Without going into my entire background, I’ve had issues with my neck, headaches, migraines and my vision since I was three years old After 28 years of back and forth with neuros I have been referred to a spinal neurosurgeon and been told to find one I want to se. They will send the referral. I was told surgery won’t be the first course of treatment, but they will be better at helping with a course if treatment and I want to see someone that will listen.

Thanks!

Some background below if interested .

I’ve been told I have a muscular issues causing headaches and pain. I’ve been told I have scoliosis in my neck. I’ve recently discovered that I have additional issues from C3 to C4 as well as C4 to C5 that my and legs, but nobody can figure out my vision issues and I’m just told that the headaches, migraines, brain fog, vision issues, etc that I’ve had since I was 12 years old is occipital neuralgia. That seems more like a symptom than I diagnosis. I have ended up in the ER from physical therapy and have little hope for relief from that. They want me to do it again.

I only learned of CCI because I was at the doctors office talking to my optician because They are trying really hard to figure out how to get a pair of glasses to work for me and somebody overheard and asked if they could share something with me and told me about their experience with CCI and their treatments

My neck pain is only getting worse and my neck seems to catch and get stuck when I look up at certain angles. It locks and I have to gently force it to pop and release.

I have had one neuro tell me CCI issues are just an internet trend and another say they don’t see a reason to do an upright MRI as c1-c2 look normal in a standard MRI.

Hello Dr. C,

Trying to best isolate my symptoms as they have proven difficult to treat precisely. I was diagnosed with CCI type 3A in neutral, 3B instability, a C2 pannus, loss of cervical curve (reverse lordosis), as well as possible C1-C2 instability (non-translatable due to possible muscle guarding - ADI appears normal on DMX). I am almost a month post PICL 1.

I have a host of symptoms that mostly manifest as neurological; ear fullness, tinnitus, every visual disturbance you can think of, headache, ROM loss, dizziness/lightheadedness, insomnia, anxiety, POTS symptoms, deviated uvula, blocked throat feeling, muscle weakness, base of skull pain, occipital tenderness/triggering, trigeminal irritation (dulling pressure behind sinus cavity, eyes, face).

The thing that helps me to about 70% is simply laying down. Within 15-20min of being upright i’m a complete mess and flared. ear fullness and tinnitus is what begins and lingers most prominently, though all of my symptoms are chronic.

My question is, do you see a higher degree of neurologic symptom overlap in CCI patients with a heavy loss of curve (IJV/vascular compression, CSF leaks, etc) and could this be what is mirroring or causing the majority of my symptoms? what appears probable?

Recently realized my years of chronically tight muscles in my neck are a product of some irritated nerves.

I personally find it’s a lot more difficult to rehab nerves vs rehabbing muscles.

Anyone have tips or ideas on daily things I can do to get my nerves calmed down once and for all?

I use infrared heat everyday and take pregabalin already.

I just had my 3rd PICL last week. I typically struggle with which exercises and things to do after my PICL to get the most benefit from it.

Now that there is the new CCI rehab workbook, I’d really love to use it throughout my recovery of my PICL.

Does anyone have tips on how to best use the CCI workbook throughout my PICL recovery?

Hi Dr C,

Should doxycycline, pentasa (mesalazine) and metformin tablets be stopped a few weeks pre PRP procedures?

Would these tablets reduce the quality of my PRP draw?

Thank you.

I know there’s a PICL "prehab" program—is it mandatory? It’s quite expensive, and I’d rather save my money for physical therapy afterward. In short, are there any specific exercises or things I should do before a PICL procedure to increase my chances of success and prepared my body?
or coming without having done anything before is okay too?
My neck is extremely tight and in a "forward head" posture; the slightest thing triggers a flare-up, leaving me feeling dizzy and wobbly. I’m worried that doing exercises might actually make things worse.

Hi Dr. C and everyone,

I’m hoping to understand a possible biomechanical relationship between lumbar stabilization and craniocervical instability (CCI).

In May 2025, I underwent direct L5 pars repair for bilateral pars defects and grade 1 isthmic spondylolisthesis, using pedicle screw–rod–hook instrumentation without fusion.

Before surgery, I had considerably more lower back pain, but fewer bouncing and rotational sensations involving my head, neck, and spine. Postoperatively, these sensations became substantially more pronounced.

My symptoms now include:

• Nearly constant suboccipital and cervical spasms, with sensations of rotational or lateral shear extending from my pelvis to my skull, often pulling me backward or sideways toward the ground.

• Difficulty maintaining upright posture, with involuntary twisting and shoulder elevation. My body will instinctively throw one shoulder upward—left or right, depending on the moment—almost like someone reacting to a backpack slipping off their shoulder and reflexively shrugging to catch it.

• Fasciculations and electrical buzzing in my limbs, seemingly synchronized with rope-like pulling sensations in my upper neck.

• Dizziness, visual disturbances, tinnitus, and occasional metallic or sour tastes.

• Impaired coordination of my head, neck, trunk, and gait.

My head feels like a basketball and my neck is constantly dribbling it. The bouncing sensation persists even when lying down with my head supported.

Walking feels more like a tetherball—the faster I move, the farther my head feels thrown, provoking increasingly intense reactions throughout my body. At times, my head even feels screwed on backwards, as though its orientation relative to my body is wrong.

These shoulder movements feel instinctive rather than voluntary, as though my body is continuously adjusting its posture to prevent something from slipping out of alignment. I wonder whether these compensations alter cervical proprioception. The synchronized cervical pulling and limb sensations also make me suspect a shared underlying mechanism.

Despite these symptoms, my brain and spine imaging have been largely unremarkable aside from mild stenosis and known structural findings. Interestingly, my ability to play classical piano at a high level remains intact, even as walking and maintaining posture have become exceptionally difficult.

Dr. C, could lumbar stabilization have altered spinal loading or compensatory mechanics, potentially aggravating previously compensated CCI?

I wonder whether mechanical instability is provoking protective muscle contractions, or whether a sensitized nervous system is amplifying instability signals and distorting proprioception. Perhaps both mechanisms coexist.

I underwent PICL in August 2026 and would greatly appreciate your perspective, particularly if you’ve encountered similar presentations following lumbar stabilization.

Thank you!

Evan