Cranio Cervical Instability in EDS

When the Neck and Head Move Too Much

Cranio‑cervical instability (CCI) means that the bones at the top of your neck and the bottom of your skull move more than they should. These bones normally protect the brainstem, the spinal cord and important nerves. If they shift too much, they can press on these delicate structures and cause many symptoms, like headaches, dizziness, trouble swallowing or even feeling like your head is too heavy for your neck.

Doctors can see signs of CCI by taking special pictures of the neck (like dynamic MRI or X‑ray), and by measuring angles between the bones. But sometimes pictures alone are not enough. Doctors need to know if fixing the neck position will make a person feel better. That’s where cervical traction comes in.

What Is Cervical Traction?

Cervical traction gently pulls your head upward. It uses weights, pulleys, or a device called a halo vest to place tension on the neck. The goal is to straighten and align the bones. This upward pull can take pressure off the brainstem and spinal cord. During traction, doctors watch how the person feels. If symptoms improve, the doctors learn that the extra movement in the neck is causing the problems.

Traction can be done in different ways:

• Manual traction – Dr. Chopra gently applies traction on your head with his hands for a short time.
• Invasive traction – For more accurate measurements, Paolo Bologenese, MD (Neurosurgeon in NYC) places small screws under sedation to the skull and attached to a pulley system. While applying gentle traction, x-ray pictures are taken and responses are recorded. People with cranio cervical instability are amazed by how much better they feel. Once Dr. Bolognese determines the precise amount of traction needed, that is the same traction applied when patients go under anesthesia for the surgery. A simple analogy to explain this is that when something breaks, we make sure that the broken parts are in the best position before applying super glue. He is the only neurosurgeon who uses this approach in cranio cervical instability and his outcomes are excellent. Neurosurgeons who do not use this approach have poor outcomes and patients wind up getting more and more neck surgeries. Most neurosurgeons simply look at an MRI of the neck and go ahead with the fusion. If a tire on your car is loose the only way to figure out which one is loose is to look at the car while its moving.

Why Traction Helps Diagnosis

When doctors try traction, they look for changes in how the patient feels. Improvements during traction can show whether a person might benefit from surgery to fuse the unstable joints. If applying traction to the head relieves symptoms—like headaches, dizziness or weakness—it suggests that the neck bones pressing on the brainstem are causing the issues. This gives doctors confidence that stabilizing the bones might help.

Traction is also reversible. If symptoms get worse, the traction can be stopped right away. This makes it a safe test compared with trying surgery first.

What Does the Research Say?

A recent case series from 2024 looked at 21 people with Ehlers‑Danlos syndrome who had craniocervical instability. These patients tried halo‑vest traction before any surgery. They filled out questionnaires about headaches, vision problems, balance, and other symptoms. After traction, many symptoms improved; headaches improved by 57%, brainstem functions (like swallowing and breathing) improved by 71%, and balance problems improved by 55%. Sixteen of the 21 patients felt enough relief that they later chose to have surgery to fuse the unstable bones. The study concluded that traction is a simple and effective way to test whether surgery will help and also provides temporary relief.

What It Feels Like

Patients often describe immediate relief when traction takes pressure off the brainstem. For example, one person with myalgic encephalomyelitis reported that at a certain amount of traction, she suddenly felt “normal” for the first time in years—her dizziness and fatigue disappeared when her head was lifted. Such experiences, while personal, show how traction can help identify the mechanical problem.

Is Traction Safe?

Cervical traction should always be performed by skilled medical professionals. It can cause discomfort or, in rare cases, make symptoms worse if done incorrectly. It is not a cure by itself; rather, it is a test and sometimes a temporary treatment.

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