Marc Darrow, MD, JD
A 24-year-old woman describes seven weeks of symptoms. She has no major trauma history or known Ehlers-Danlos syndrome. Most of her earlier neurological, visual, and autonomic symptoms improved within the first four weeks without treatment. Head pressure and a feeling of heaviness in her neck remain. Brain and full-spine MRI were reportedly normal apart from a slight reversal of the cervical curve. A NUCCA assessment described C1 and C2 as rotated and tilted.
She asks whether she might have craniocervical instability (CCI) or atlantoaxial instability (AAI), and whether Wharton’s jelly could be injected near those areas.
The first question is whether instability has actually been established. An alignment description, a heavy-head sensation, and a normal routine MRI do not individually settle that question. They also do not establish an indication for a regenerative injection.
I would separate the diagnostic question from the treatment question. Before considering what to inject, the assessment needs to determine what structure, if any, requires treatment and whether the proposed procedure has evidence relevant to that problem.
CCI and AAI describe related but different problems
Craniocervical instability concerns abnormal stability at the junction between the skull and upper cervical spine. Atlantoaxial instability specifically concerns the relationship between C1, the atlas, and C2, the axis. Terminology sometimes overlaps, so the actual joint, ligament, and abnormal movement being proposed should be identified.
The important distinction is between alignment and instability. Alignment describes how structures appear in a particular position. Instability concerns an inability to maintain appropriate relationships under physiological loading or movement. A head position on an image cannot automatically establish the latter.
Neither term should be used as a catch-all explanation for head pressure, dizziness, visual symptoms, or autonomic complaints. Such symptoms can warrant medical assessment, but they have multiple possible causes.
What does a report of C1–C2 rotation or tilt mean?
C1–C2 normally contributes substantial rotation when the head turns. The appearance of the joint can also depend on positioning and individual anatomy. A statement that the bones are “rotated” therefore needs context: what image was obtained, in what position, how was it measured, and what finding distinguishes the result from normal variation?
A 2025 CT study examined 100 patients without prior neck trauma or prolonged neck complaints. Ninety-eight percent had at least one finding of C1–C2 rotation, dens asymmetry, or facet misalignment. The authors interpreted the observed findings as normal variations rather than evidence of instability. This does not mean that every degree of displacement is normal; it means that an alignment difference alone is insufficient. (1)
This study used CT, not NUCCA radiographs. It cannot directly validate or invalidate an individual NUCCA measurement. Its useful lesson is that a diagnosis needs more than the word “misalignment.” A NUCCA alignment assessment is not, by itself, confirmation of pathological ligament failure.
If the actual images and reports have not been reviewed, no responsible conclusion can be drawn about this patient’s C1–C2 relationship from the description alone.
No major trauma or EDS: does that rule instability out?
No, but the history affects which explanations are plausible and how findings should be interpreted. Known connective-tissue disease, inflammatory disease, congenital abnormalities, trauma, and other clinical features can change the assessment. Their absence should not be replaced by an assumption that an unrecognized ligament injury must be present.
Much of the published discussion of CCI involves selected patients with Ehlers-Danlos syndrome. A systematic review found a lack of high-quality prospective evidence and emphasized that radiographic findings must agree with symptoms and signs before surgical fixation is considered. Its evidence was specific to EDS-related evaluation and cannot simply be transferred to a young person without that diagnosis. (2)
The same care in matching findings to symptoms is relevant before an injection. Research uncertainty does not justify assuming instability, and a patient’s symptoms should not be dismissed merely because the diagnosis remains unclear.
What does a normal brain and spine MRI tell us?
A normal reported MRI is reassuring about the structures adequately examined, within the limits of the protocol and interpretation. It does not explain every symptom or test every aspect of movement-dependent stability. However, it also does not become evidence that instability is present but hidden.
A routine MRI is usually obtained in a relatively fixed position. If the examination or existing images raise a specific concern about upper-cervical stability, a specialist may consider additional targeted investigation. That does not mean everyone with head pressure needs upright MRI, rotational CT, or a battery of dynamic studies.
Further imaging should answer a defined clinical question and use a protocol that can be interpreted meaningfully. Radiation exposure, positioning, and whether the result would change care matter. Provocative neck movements should not be improvised at home to test for instability.
The site’s ultrasound-versus-MRI guide explains why the tests answer different questions. A routine external ultrasound is not a substitute for evaluating the spinal canal or a comprehensive instability assessment.
Does a slight reversal of the neck curve prove ligament damage?
No. Cervical curvature varies with anatomy, posture, positioning, and measurement technique. Forward-head posture and a reported curve reversal are also different observations; one should not be assumed to have caused the other from a brief report.
A meta-analysis involving more than 15,000 asymptomatic individuals found considerable variation in cervical curvature. Not everyone without symptoms had a conventional lordotic curve. This does not make alignment irrelevant, but it cautions against treating loss of lordosis as a stand-alone explanation for symptoms or proof of upper-cervical ligament failure. (3)
An alignment finding becomes more useful when it fits the examination and a clearly defined clinical problem. It does not, on its own, identify an injection target.
How should the early improvement affect the decision?
The improvement in most symptoms during the first four weeks is important. It suggests that the clinical picture has changed and that the current problem should be assessed as it is now. It does not prove either that an instability resolved or that one was present originally.
Head pressure and heaviness are real complaints, but they are nonspecific. Depending on the history and examination, headache disorders, muscle-related neck pain, visual or vestibular conditions, sleep problems, and other causes may need consideration. Head pressure alone does not diagnose raised intracranial pressure, venous obstruction, brainstem compression, or CCI.
At seven weeks, a treatment decision should account for the improving trajectory, remaining disability, examination, and alternative explanations. Improvement without a particular treatment also means later improvement should not automatically be attributed entirely to that treatment if it is started.
The aim is neither indefinite waiting nor immediate escalation. It is a proportionate assessment of the persistent symptoms before an invasive intervention.
What is Wharton’s jelly, and is it a stem-cell injection?
Wharton’s jelly is connective tissue within an umbilical cord. A processed donor-tissue product is not the same as cord blood, a patient’s own bone marrow concentrate, PRP, or cells grown in a laboratory. Its source does not establish the viable cell content, dose, or clinical activity of the final preparation.
The research reviewed for this article did not identify established clinical evidence showing that non-expanded Wharton’s jelly repairs the alar or transverse ligaments, corrects AAI or CCI, or treats this combination of head pressure and improving symptoms. Laboratory work or research involving cultured cells cannot establish the efficacy of a different injected tissue product.
FDA consumer guidance specifically includes Wharton’s jelly among unapproved regenerative products and states that the therapies discussed have not been approved for orthopedic conditions, including neck pain. “FDA registered” should not be presented as equivalent to approval for the proposed treatment. (4)
Do PRP or other cervical injection studies answer this question?
There is preliminary clinical research involving platelet products and prolotherapy for neck pain. A 2021 uncontrolled case series included 14 patients receiving combinations of these treatments and reported pain and functional improvement. Because there was no control group and multiple treatments were combined, it cannot establish which component helped or prove efficacy for suspected upper-cervical instability. (5)
It also did not test Wharton’s jelly. Evidence involving a different preparation, target, and diagnosis should not be used to promise the same result here. Improvement in neck pain is different from demonstrated restoration of ligament stability.
These distinctions allow emerging research to be discussed without converting it into a treatment guarantee. “Regenerative” describes an intended biological approach, not proof that an injured ligament has been repaired.
Can an injection be given “near C1–C2”?
That description is too broad to determine safety or suitability. A superficial muscle or ligament attachment, an upper-cervical joint, a deep stabilizing ligament, and the epidural space are different targets. Being close to an area of concern is not equivalent to reaching or treating the structure thought to be responsible.
Upper-cervical procedures require particular anatomical care because important arteries, nerves, and central nervous system structures are nearby. Multispecialty guidance for cervical joint interventions discusses target-specific imaging, anatomical variation, and potential vascular or neurological complications. Those recommendations concern the procedures studied; they do not validate Wharton’s jelly injections into stabilizing ligaments. (6)
Image guidance can improve knowledge of needle location, but it does not establish the diagnosis, make every route appropriate, or eliminate risk. Pain relief after an injection also does not demonstrate that CCI or AAI was corrected.
This article cannot confirm which deep upper-cervical procedures a particular clinic performs. Availability, target, clinician qualifications, product, regulatory status, and suitability would need direct verification. It would be inaccurate to promise an injection into the reader’s concern area from this account.
When should symptoms be assessed urgently?
New or progressive weakness, difficulty walking, loss of hand coordination, or new bladder or bowel dysfunction requires urgent medical assessment. A sudden severe headache, new double vision, trouble speaking or swallowing, or other new focal neurological symptoms also warrants urgent evaluation, including emergency care when sudden or severe.
These signs should not automatically be assigned to CCI or managed by waiting for a regenerative consultation. Conversely, the absence of those signs does not establish a specific diagnosis.
For the situation described, the reported improvement and normal routine imaging are relevant reassuring information, while the remaining symptoms still deserve attention. C1–C2 rotation or tilt alone does not prove CCI or AAI, and the available evidence does not establish Wharton’s jelly as the solution. Clarifying the diagnosis is the step that makes a treatment decision meaningful.
References
1 Peltonen H, Berghem K, Ortiz R, Honkaniemi J. Variations in the atlantoaxial joint detected by computed tomography in control patients. Radiography (Lond). 2025;31(6):103183. doi:10.1016/j.radi.2025.103183.
2 Lohkamp LN, Marathe N, Fehlings MG. Craniocervical Instability in Ehlers-Danlos Syndrome-A Systematic Review of Diagnostic and Surgical Treatment Criteria. Global Spine J. 2022;12(8):1862-1871. doi:10.1177/21925682211068520.
3 Guo GM, Li J, Diao QX, Zhu TH, Song ZX, Guo YY, Gao YZ. Cervical lordosis in asymptomatic individuals: a meta-analysis. J Orthop Surg Res. 2018;13(1):147. doi:10.1186/s13018-018-0854-6.
4 U.S. Food and Drug Administration. Important Patient and Consumer Information About Regenerative Medicine Therapies. FDA consumer guidance. Accessed October 21, 2026.
5 Williams C, Jerome M, Fausel C, Dodson E, Stemper I, Centeno C. Regenerative Injection Treatments Utilizing Platelet Products and Prolotherapy for Cervical Spine Pain: A Functional Spinal Unit Approach. Cureus. 2021;13(10):e18608. doi:10.7759/cureus.18608.
6 Hurley RW, Adams MCB, Barad M, et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Reg Anesth Pain Med. 2022;47(1):3-59. doi:10.1136/rapm-2021-103031.