FOR CRANIOCERVICAL INSTABILITY
The following lays in detail the three-step screening process all prospective patients must undertake before they are seen by our practice:
IF YOU SUSPECT CRANIOCERVICAL INSTABILITY, IT IS VERY IMPORTANT THAT YOU FOLLOW THE INSTRUCTIONS BELOW, TO AVOID DELAYS IN THE SCREENING OF YOUR CASE
1. TRIAL OF CERVICAL TRACTION
First, you will undergo a trial of cervical traction, using one of the following options, as individually tolerated:
For the over the door traction device, we suggest the following item: click here
Keep a TRACTION JOURNAL, recording how your top three symptoms are:
Keep in mind that in some cases a transient rebound effect can occur after the removal of traction.
By rebound we mean a temporary exacerbation of pre-traction symptoms, appearing upon release of traction, and lasting from a few minutes up to a few hours (rarely into the following day).
This rebound is often an indicator of higher degrees of clinical instability.
If you had an initial positive traction result, but the rebound is extremely debilitating, you should stop the trial, notify us by email, and proceed directly to the next diagnostic step (MRI).
If DURING the traction you experience SEVERE pain in mandible, occiput, or neck, the trial should be aborted, and we should be notified by email.
In these cases, we will discuss and identify alternative forms of provocative diagnostic trial.
WITHIN THE LIMITS INDICATED ABOVE, these modalities of traction have a very low chance to cause permanent damage to your Craniocervical Junction, and have a risk comparable to many other activities of your daily living, such as being in a moving car or walking on a treadmill.
Chiropractic maneuvers or wearing a cervical collar for more than 4 hours a day have a much higher chance of permanently affecting the stability of your Craniocervical Junction than the currently suggested trial of traction (if used within the limits suggested above).
We again stress that severe problems experienced during traction should automatically lead to aborting the trial.
Save the TRACTION JOURNAL in a WORD file.
Keep it short and to the point, to facilitate the review.
This JOURNAL needs to be emailed to us, along with the other electronic paperwork files.
If the trial of traction does not provide dramatically positive results, proceeding with these next steps is NOT indicated.
EXCEPTIONS to this rule:
2. CERVICAL MRI
If you obtain dramatically positive results DURING traction, then proceed with obtaining a supine MRI of the Cervical spine.
The MRI of the Cervical spine should have the following features:
3. If you already have a recent MRI of the Cervical spine with these features, you do not need to get another one. (For “recent” MRI, we mean obtained less than 12 months ago)
Remember that experiencing a rebound of your symptoms AFTER the end of the traction makes the traction trial results even more POSITIVE.
In these cases, you should proceed with a supine MRI of the Cervical spine, with the features indicated above.
4. SUBMITTING THE CERVICAL MRI AND ELECTRONIC PAPERWORK
After obtaining the Cervical MRI you can schedule a videoconference by following the instructions below:
FOLLOW LINK BELOW TO REVIEW TELEMEDICINE TERMS
COVID-19 INSTRUCTIONS - PLEASE FOLLOW THESE INSTRUCTIONS BELOW TO COMPLETE AND MAIL APPROPRIATE DOCUMENTS
* EMAIL TO MS. PENDERGAST AT firstname.lastname@example.org
We will review the information.
You will be then informed if your case is:
The review process has three outcomes:
The screening process is not a substitute for a consultation, therefore diagnoses and therapeutic recommendations will only take place and be given at the time of the consultation.
In every case, the files and the imaging are all personally reviewed by the Physician in charge
Cases are ACCEPTED or NOT ACCEPTED according to the qualifying criteria of our Center.
Since there are no fixed national or international standards of care regarding Chiari I Malformation, our diagnostic and therapeutic parameters are not necessarily the same as you will find at other Centers.
Nevertheless, our criteria have been tested and refined over more than 20 years of practice in this focused field, and more than 10,000 patients like you.
FREQUENTLY ASKED QUESTIONS
What happens if my case is not accepted?
If NOT ACCEPTED, no further details will be given due to the limits of our Center’s capacity. In this case, please feel free to seek the help of other Centers specializing in this field.
Exception: if you previously submitted your case WITHOUT a traction journal and your case was rejected, you can send your traction journal to Ms. Pendergast if and only if you had a dramatic and replicable positive response to traction.
What insurance do you accept?
The Physicians of our Centers are Employees of a larger practice.
The practice does not accept Medicaid or HMO Medicaid insurances.
A number of other qualified Centers in the Country do accept these insurances.
How do I get a prescription for a cervical MRI?
We cannot provide you with the scripts for the MRI or other types of diagnostic tests we recommend during the screening process, since you will formally become our patient at the time of the first consultation.
You will have to ask your PCP for these scripts.
Why do you offer remote consults?
Office visits are not equivalent to remote evaluations by videoconferencing, for obvious reasons.
Remote evaluations are logistically and economically convenient for long distance patients, who are the majority.
Refer to our staff for details concerning insurance coverage and possible fees associated with videoconferencing vs in-person encounters.
Why do you prefer a closed, supine MRI?
What if I can’t access a 3 Tesla MRI?
What about Upright MRIs?
What about DMX studies?
At this point in time, our Center considers DMX imaging only as ancillary information.
The electronic files from DMX studies are not compatible with our imaging reviewing systems and often end up crashing them.
If you have had a DMX study, you should email us the DMX report as a PDF file.
What imaging data format do you require?