CBCT in Chiropractic

CBCT is a technology that was first developed by the dental profession to better image the jaw structure for dental implants.

Now CBCT is the new generation of imaging that allows for precision in upper cervical junction, more precisely called the cranio-cervical junction (CCJ), care like never before. This imaging technology can precisely detect spinal misalignments that are impacting the central nervous system. Upper neck (CCJ) CBCT provides a 3D picture of the cervical spine and its relation to the cranium.

One third of reported traumas in the cervical spine occur at the CCJ. The CCJ may be closely correlated to brain health with consideration to concussion and post-concussion syndrome. The prevalence of injury to the CCJ area can affect the osseous alignment resulting in neurologic and vascular implications that warrant increased clinical consideration, including detailed imaging.

Cervical spine scans play a crucial role in the evaluation of patients who are experiencing these conditions. We are excited about this new technology as it allows the chiropractor to analyse images that give better detail that simply is not possible with X-ray.

When undertaking a CBCT cervical spine scan, this is normally performed in a seated or standing position which is more representative of the spine’s normal upright orientation. 

The radiation exposure is much less than standard X-ray series. A standard CBCT scan is 240 micro sieverts, which is equivalent to about 1/10th the radiation exposure of a standard 4-view cervical spine X-ray series. This is equivalent to the exposure of a 5-hour airplane flight (due to less shielding from cosmic radiation at higher altitudes!)

Since the human structure is 3-dimensional, it is vital to view it with 3D imaging in order to accurately evaluate the alignment. Traditional X-ray is 2-dimensional, so certain factors like anatomical variations, positioning errors and asymmetry of structures can result in misdiagnosis some of the time.

The cranio-cervical junction (CCJ) plays an important role in the overall motion of the cervical spine, accounting for 25% of the flexion and extension, and up to 50% of the axial rotation of the neck.

Upper neck cervical CBCT is used to identify density of bone, fractures, skeletal maturation, cervical fusion assessments, cervical and temporomandibular joint instabilities, atlanto-occipital instability, bony alignment and styloid pathologies.

The detail of bony anatomy provided by a CBCT image of the CCJ is useful to appreciate the components of the CCJ and its role in cervical spine stability and clinical implications.

The CCJ is an area of unique consideration given bone morphology, biomechanics, ligamentous structures, fluid dynamics, neurology, and neurophysiologic effects attributed to that area.

Additionally, CBCT may be indicated to evaluate for traumatic fractures and hairline fractures within the cervical spine. It may also be used to evaluate cervical spine spondylosis, intervertebral foraminal stenosis, and facet joint arthrosis. These abnormal findings are regularly evaluated for in chiropractic offices that specialise in the cranio-cervical junction.