If you’ve been diagnosed with — or are being evaluated for — craniocervical instability (CCI) or a Chiari malformation, you’ve probably already heard a lot of complicated terminology from your medical team. One piece that’s often left out of that conversation is the atlas, the very top bone of your spine, and the role it may play in how you feel day to day. At Desoto Upper Cervical in Southaven, MS, Dr. David Hall and Dr. Troy Reistroffer specialize in evaluating the alignment of this single vertebra using Atlas Orthogonal and Orthospinology techniques. This article explains what CCI and Chiari malformation are, how they relate to one another, and where upper cervical chiropractic care realistically fits into the picture.
Important note before we go further: Craniocervical instability and Chiari malformation are structural, medically diagnosed conditions. Upper cervical chiropractic care does not diagnose, treat, cure, or reverse either condition, and it is never a substitute for evaluation by a neurologist or neurosurgeon. What upper cervical care can do is assess whether the alignment of the atlas and axis is adding unnecessary mechanical stress to an already sensitive area — and address that piece specifically, alongside your existing medical care.
Table of Contents
What Is Craniocervical Instability?
Craniocervical instability refers to excessive movement between the skull (cranium) and the top of the spine, most often involving the joint between the atlas (C1) and axis (C2). Normally, ligaments in this area hold the skull securely in place while still allowing the wide range of motion your neck needs. When those ligaments become lax — due to connective tissue disorders, trauma, or other causes — the skull can shift slightly on the spine in ways it shouldn’t, which may place stress on the brainstem and upper spinal cord.
Symptoms associated with CCI can include severe headaches or neck pain, dizziness, visual disturbances, difficulty swallowing, and a sense of pressure at the base of the skull. Diagnosis typically requires specialized imaging performed in flexion and extension positions, interpreted by a physician familiar with craniocervical junction disorders.
What Is a Chiari Malformation?
A Chiari malformation, most commonly Type I, occurs when the lower part of the cerebellum (the cerebellar tonsils) extends downward through the foramen magnum — the opening at the base of the skull — into the upper portion of the spinal canal. This can crowd the space normally reserved for the brainstem and spinal cord and may interfere with the normal flow of cerebrospinal fluid (CSF). Chiari malformations are sometimes present from birth and discovered incidentally, while in other cases they become symptomatic later in life.
Research has identified a subset of cases — sometimes referred to as “complex Chiari” — where craniocervical instability exists alongside the tonsillar descent. In these cases, the instability itself is thought to contribute meaningfully to symptom severity, separate from the malformation alone.
Where the Two Conditions Overlap
CCI and Chiari malformation aren’t the same condition, but they frequently show up together and can amplify one another. Both involve the same small, densely packed anatomical neighborhood: the base of the skull, the atlas, the axis, the brainstem, and the pathways that carry cerebrospinal fluid and blood to and from the brain. When there’s instability in this region on top of an existing malformation, even small amounts of extra movement or misalignment can meaningfully affect how a person feels.
This is exactly why the biomechanics of the upper cervical spine have become a genuine, though still developing, area of interest among researchers and clinicians working with craniocervical junction disorders.
How the Atlas Relates to Brainstem and CSF Function
The atlas is unique among all 33 vertebrae in the spine. It has no disc, sits directly beneath the skull, and encircles the point where the brainstem transitions into the spinal cord. Because of this position, even a small misalignment of the atlas can change the mechanical environment around the brainstem, the vertebral arteries that pass through it, and the surrounding tissues involved in CSF flow.
To be clear, upper cervical misalignment does not cause craniocervical instability or a Chiari malformation, and correcting it will not move the cerebellar tonsils or resolve ligament laxity. What it may do is reduce unnecessary mechanical tension in a region that’s already under structural stress — which is the rationale behind evaluating atlas alignment as one piece of a much larger care picture that should always include your neurologist or neurosurgeon.
Atlas Orthogonal and Orthospinology: How These Techniques Work
Both techniques used at Desoto Upper Cervical are built around precision rather than force. Neither involves the twisting or “cracking” adjustments people often associate with general chiropractic chiropractic care.
Atlas Orthogonal
This technique uses detailed imaging to measure the precise position of the atlas in three dimensions. Corrections are delivered using a gentle, instrument-assisted procedure that requires no manual thrusting or twisting of the neck, which makes it a particularly cautious option when the craniocervical junction is already a sensitive area.
Orthospinology
Orthospinology also relies on detailed structural analysis of the upper cervical spine, using precise measurements to guide a light, specific correction aimed at restoring more normal alignment between the head and neck, again without high-velocity manipulation.
Because these approaches are so specific and gentle, Dr. Hall and Dr. Reistroffer are able to work carefully with patients who have complex neurological histories — always in coordination with, not in place of, the patient’s medical team.
Could Upper Cervical Misalignment Be Adding to Your Symptoms?
This checklist isn’t a diagnostic tool for CCI or Chiari malformation — only imaging and a physician can determine that. It’s simply a way to think about whether an upper cervical evaluation might be a reasonable addition to your current care team. You may want to have your atlas alignment checked if you:
- Have a diagnosed or suspected Chiari malformation or craniocervical instability and haven’t had your upper cervical alignment specifically assessed
- Experience headaches or neck pain that seem to worsen with certain head positions or activity
- Notice dizziness, balance issues, or pressure at the base of the skull
- Have a history of whiplash, concussion, or other trauma to the head or neck
- Have a connective tissue disorder (such as Ehlers-Danlos syndrome) alongside neurological symptoms
- Have already had craniocervical or Chiari-related evaluation and want to understand whether upper cervical alignment is part of your overall picture
If any of this sounds familiar, the right next step is a conversation — both with your treating physician and, if appropriate, with an upper cervical chiropractor who can evaluate atlas alignment specifically.
What to Expect at Desoto Upper Cervical
A visit begins with a thorough consultation and health history, followed by precise imaging to evaluate the position of the atlas and axis. Dr. Hall and Dr. Reistroffer will discuss findings with you in plain language, and if there are any indications that your case involves complexity beyond the scope of upper cervical care — which is common with CCI and Chiari cases — they will recommend working alongside, or deferring to, your neurologist or neurosurgeon. Upper cervical care is offered as a complement to your medical care, never a replacement for it.
Frequently Asked Questions
Can upper cervical chiropractic cure a Chiari malformation or craniocervical instability?
No. Both are structural conditions. No chiropractic technique repositions the cerebellar tonsils or tightens lax ligaments. Upper cervical care addresses atlas alignment only, as one small piece of a much larger medical picture.
Is it safe to see an upper cervical chiropractor if I have CCI or Chiari?
Every case is different, which is why imaging, a detailed history, and communication with your medical team are essential first steps. Techniques like Atlas Orthogonal and Orthospinology are gentle and avoid high-velocity manipulation, but any patient with a known instability or malformation should have their treating physician involved in the decision.
What’s the difference between craniocervical instability and Chiari malformation?
Chiari malformation is a structural descent of the cerebellar tonsils through the foramen magnum. Craniocervical instability is excessive movement between the skull and upper spine, often due to ligament laxity. They can occur separately or together, and when they occur together, symptoms are often more pronounced.
Will upper cervical care show up on my Chiari imaging?
Upper cervical imaging used at Desoto Upper Cervical is specifically designed to evaluate atlas and axis alignment and is different from the neuroimaging (such as MRI) your physician uses to evaluate the craniocervical junction itself. The two serve different purposes and are not interchangeable.
Do I need a referral from my neurologist or neurosurgeon before visiting?
A referral isn’t required, but if you have a diagnosed condition affecting the craniocervical junction, we strongly encourage you to loop in your treating physician so your care stays coordinated.
What symptoms might improve with upper cervical care?
Some patients report changes in headache frequency, neck tension, or a sense of pressure when mechanical stress on the upper cervical spine is reduced. Results vary by individual, and upper cervical care should be viewed as a potential complement to — not a replacement for — your medical treatment plan.
How is Atlas Orthogonal different from a regular chiropractic adjustment?
Atlas Orthogonal uses precise imaging and an instrument-assisted, non-manual correction focused solely on the atlas. It doesn’t involve the twisting or thrusting motions used in general spinal manipulation, which makes it a more conservative option for this sensitive area of the spine.
Talk to an Upper Cervical Specialist in Southaven
If you’re managing craniocervical instability or a Chiari malformation and want to understand whether your atlas alignment is part of the picture, Dr. David Hall and Dr. Troy Reistroffer are here to help — always working alongside your existing medical care, never in place of it. Reach out to Desoto Upper Cervical at (662) 393-4848 or visit us at desotouppercervical.com. Our office is located at 1134 Church Rd W, Southaven, MS 38671 — get directions on Google Maps.
