Walid Bashouri


The aim of this case study was to review the anatomic and radiographic findings associated with post traumatic alar ligament instability. The craniovertebral junction is the most mobile region of the cervical spine and its stability is thus of utmost importance. The intricate alar ligaments play a crucial role in maintaining this stability and protecting the craniovertebral junction from excessive contralateral rotation and/or lateral flexion. When alar ligament injury is suspected, for instance following a significant whiplash injury, as was in this case, a thorough radiologic examination should be carried out. The atlanto-dental interspace and para-odontoid spaces should be assessed in both neutral and stressed positions to rule out any instability. If these above measurements are within normal limits, upper cervical neurologic concern is reduced and chiropractic care can begin. If alar ligament instability is noted however, conservative chiropractic care can still proceed but with the use of low force techniques when addressing the upper cervical spine