Cone Beam CT of the Upper Cervical Spine: Indications and Utilization in Chiropractic

Written by: James Demetrious, DC, DABCO

Board Certified Chiropractic Orthopedist

Cone Beam Computed Tomography (CBCT) has emerged as a sophisticated imaging technology predominantly used in dental and maxillofacial applications. However, its utility in visualizing the bony anatomy of the upper cervical spine is gaining attention, particularly within the field of chiropractic care. CBCT’s precise, three-dimensional imaging capabilities provide detailed insights into the skeletal structures critical for diagnosing various upper cervical spine conditions.

Technical Advantages of CBCT

CBCT captures volumetric data using a rotating gantry that sends divergent x-rays through the targeted area, constructing three-dimensional images. The advantage over traditional radiography is CBCT’s high spatial resolution and comparable low radiation dose. Compared to traditional CT, CBCT provides sufficient detail with much less radiation exposure, which is crucial in regions sensitive to radiation, like the cervical spine (Bajada, S., and Burrage, J., 2020).

A unique capability of CBCT is the acquisition of images in an upright, weight-bearing posture with the advantage of flexion/extension, lateral flexion and even rotational stress views. Such images may provide insight into osseous instability due to ligamentous insufficiency. It is important to denote that research is needed to define normative values in asymptomatic cohorts of varied ages and genders.

Indications for CBCT in the Upper Cervical Spine

Chiropractors often encounter clinical conditions where CBCT could offer definitive insights:

  • Traumatic and Non-Traumatic Instability:
    • The upper cervical spine, particularly the atlantoaxial (C1-C2) region, is susceptible to instability, which may arise from trauma or degenerative ligament conditions. CBCT allows visualization of fine bony details, helping to assess alignment and integrity crucial for identifying such instabilities (Niu, F., et al., 2018).
  • Atlantoaxial Misalignment:
    • Chiropractors may be able to better plan their therapeutic adjustments using CBCT to identify rotational or translational abnormalities that commonly occur in the C1-C2 segment. This is pivotal for patients reporting symptoms that suggest a mechanical component, like headaches or vertigo (Grunert, P., et al., 2017).
  • Chronic Pain Evaluation:
    • Chronic pain conditions, particularly when associated with musculoskeletal issues of the cervical spine, can benefit from CBCT’s thorough cartography of bone abnormalities, sclerotic changes, or arthritic conditions.

CBCT in Chiropractic Education

Currently, Life West and Sherman College have CBCT units on campus and offer related coursework. This is an important for standard of care concerns.

Utilization of CBCT in Chiropractic Practice

Proper CBCT utilization in chiropractic involves integrating its findings into the broader clinical assessment. Chiropractic care for the cervical spine revolves around precise diagnosis, which is used to tailor manipulative therapies accurately.

  • Diagnosis and Treatment Planning:
    • CBCT enables chiropractors to extrapolate detailed anatomical information that may not be visible on plain radiographs, aiding in the diagnosis of structural issues and facilitating personalized care strategies (Scarfe, W. C., & Farman, A. G., 2008).
  • Documentation and Progress Monitoring:
    • CBCT’s capacity to produce baseline anatomical images enables practitioners to track changes over time. This capability is particularly useful for understanding pre- and post-treatment alterations, ensuring therapeutic interventions effectively achieve intended outcomes.
  • Research and Education:
    • The increasing emphasis on evidence-based practice in chiropractic care is bolstered by CBCT’s ability to provide empirical data for study. This fosters a deeper understanding of upper cervical spine mechanics and pathology, enhancing educational frameworks and clinical research initiatives.

Conclusion

The applications of Cone Beam Computed Tomography for the upper cervical spine represent a promising integration within chiropractic care. The precision and effectiveness in lower radiation exposure compared to traditional CT give CBCT a prominent edge for chiropractors committed to non-invasive diagnostics and patient-centered care. As the technology continues to evolve, it provides a robust framework for both further research and refined clinical practice within the chiropractic domain.

References

  1. Bajada, S., and Burrage, J., “The Value of Cone Beam CT in the Cervical Spine Assessment: Clinical Implications in Chiropractic Care.” Chiropractic Journal (2020).
  2. Niu, F., et al. “Cone Beam Computed Tomography in Orthopedics.” Journal of Orthopaedic Surgery and Research (2018).
  3. Grunert, P., et al. “Clinical Applications of Cone Beam Computed Tomography in Basilar Invagination and Craniocervical Instabilities.” Neurospine Journal (2017).
  4. Scarfe, W. C., & Farman, A. G. “What is Cone Beam CT and How Does it Work?” Dental Clinics of North America (2008).

Disclosure/Disclaimer

The information provided in this article and all PostGradDC coursework should not be considered standards of care. We offer this information for educational purposes only. This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any questions you may have regarding medical conditions or treatment.

Advanced CE is available at PostGradDC.com.

© 2025 – James Demetrious, DC, DABCO. Open Access. Unrestricted use, distribution, and reproduction are allowed in any medium, provided you give appropriate credit by citing the original author and source: Demetrious J. PostGradDC. Cone Beam CT of the Upper Cervical Spine: Indications and Utilization in Chiropractic. PostGradDC.com; 2025.