Non-Surgical Management of Upper Cervical Instability via Improved Cervical Lordosis: A Case Series of Adult Patients

What the Study Looked At

Upper Cervical Instability (UCIS) happens when the top two vertebrae (C1 & C2) move excessively relative to each other—often following whiplash. In some cases, patients also lose their normal neck curve (cervical lordosis).

The researchers tested whether restoring this neck curve non-surgically could reduce instability and improve symptoms.

Who Was Included

• 9 adults with both UCIS and reduced/loss of cervical lordosis confirmed via imaging.

What They Did

Each patient underwent chiropractic care focused primarily on restoring cervical lordosis. Methods included posture correction tools like the Denneroll™, posture pump®, and traction.

What Changed

• All nine patients showed radiographic improvements—better cervical curve and reduced upper cervical instability (assessed by C1 lateral-mass overhang on C2 during lateral flexion).

• Symptoms and functional ability also improved in all cases.

Statistical Findings

Improvement in lordosis correlated with reduced instability. Regression showed R² = 0.46, p = 0.04, meaning about 46% of instability reduction can be statistically associated with curve correction.

Implications for you when you see a Chiropractic Biophysics (CBP) practitioner

• Structural correction matters: Even when instability is high, restoring the cervical curve can reduce biomechanical stress at C1–C2.

• Non-surgical option: These improvements occurred without surgery. CBP methods can address structural instability through alignment techniques.

• Objective markers work: This study used imaging and measurable anatomical markers (lordosis angle, overhang) alongside symptom changes. Good model for tracking progress in CBP.

• Clinical relevance: Suggests patients with whiplash-related instability may benefit from early curve correction to prevent chronic dysfunction.

FAQ (Frequently asked Questions)

Q: What is Upper Cervical Instability (UCIS)?

A: It’s when the first two vertebrae in your neck (C1 and C2) move too much relative to each other—often after whiplash-type injuries.

Q: Why does neck curve (lordosis) matter in this?

A: A healthy neck curve helps distribute forces and stabilize joints. Losing that curve can increase strain on the upper cervical area, making instability worse.

Q: Can restoring the curve improve my symptoms?

A: In this study, yes—for all 9 patients involved. Radiographic markers of instability improved, as did symptoms and function.

Q: Is this better than surgery?

A: This study showed significant improvement via non-surgical methods. That offers a lower-risk option, especially for patients preferring conservative care.

Q: How did they measure instability improvement?

A: They measured C1 lateral mass overhang on C2 during side bending. That overhang decreased as lordosis improved.

Q: Does lordosis restoration guarantee symptom relief?

A: Not guaranteed for everyone. This was a small case series. Larger, controlled trials are needed to generalize.

References: Katz EA, Katz SB, Freeman MD. Non-Surgical Management of Upper Cervical Instability via Improved Cervical Lordosis: A Case Series of Adult Patients. J Clin Med. 2023;12(5):1797. Published 2023 Feb 23. doi:10.3390/jcm12051797