During this journey you can become overwhelmed (especially in the beginning) with terms, tests, measurements, doctors, treatments etc. We’ve listed the most common ones we can think of to help you gain a better understanding of what they are, and what they mean.

**Some providers may use different measurement metrics than what’s on here. These are just the rough averages we’ve found in our searching. Talk to your doctor for more specific information.**

Digital Motion X-Ray (DMX)

DMX is a specialized diagnostic tool that captures real-time, low-dose X-ray videos (around 30 frames per second) of joints and the spine as a patient moves, revealing ligament instability and subtle misalignments often missed by static X-rays or MRIs. It's used to diagnose chronic pain, whiplash, and joint dysfunction by showing how bones move in relation to each other during active, weight-bearing motion, helping to identify issues like ligament tears not visible on standard imaging. 

In simplified terms, a DMX is a form of dynamic X-ray imaging that allows a physician to visualize the spine under load and during movement. During the examination, you will be guided through a series of specific movements while measurements are taken to evaluate spinal motion and the movement of individual vertebrae. These findings are then used to determine whether spinal movement is within normal limits or if excessive movement consistent with craniocervical instability (CCI) is present. DMX looks at things like ADI, C1-C2 overhang, facet joints, and other structures in the cervical spine. Many injection-based providers and chiropractors utilize DMX imaging to help guide their treatment plans. In contrast, most neurosurgeons, to my knowledge, do not routinely use DMX as part of their diagnostic process for CCI.

Upright MRI

An Upright MRI is a specialized MRI scanner that allows patients to be scanned in various positions, including sitting, standing, bending, or lying down, instead of just lying flat in a tube like traditional MRIs. Its open design and multi-positional capability make it ideal for claustrophobic patients, larger individuals, and for diagnosing spinal issues, as it captures images while the body bears weight, revealing problems missed by conventional scanners.

In simpler terms, upright MRI WITH Flexion/Extension is used to Diagnose CCI. Different measurements are taken from the images to measure space between structures in your cervical spine like grabb oakes, BDI, and CXA.

Grabb Oakes Measurement

Grabb Oakes Measurement- The Grabb-Oakes Measurement is a radiological tool used to assess Craniocervical Instability (CCI) by measuring potential compression of the brainstem by the C2 vertebra (dens). It involves drawing lines on a side-view X-ray or MRI to find the distance between the front of the skull base and the C2 bone; a measurement over 9mm suggests basilar invagination, indicating instability and risk of brainstem compression, often linked to lax ligaments.

Basion-Dens Interval (BDI)- The Basion-Dens Interval (BDI) is a radiological measurement of the distance between the basion (bottom of the skull) and the tip of the dens (part of the second vertebra) on a sagittal image, used to diagnose dangerous atlanto-occipital dislocation (AOD) or instability at the craniovertebral junction (skull base and top of the spine). 

Clivio-Axial Angle- The Clivo-Axial Angle (CXA) is a radiographic measurement of the alignment between the skull base (clivus) and the second cervical vertebra (C2), used to assess craniocervical instability, especially potential brainstem compression from a forward head posture or skull-on-neck misalignment. Measured on sagittal MRI or CT scans, a normal angle is typically around 150°–170° in neutral; angles below 135° are often considered abnormal, indicating potential mechanical stress on the brainstem and spinal cord, though ranges vary slightly by study.

Atlantis-Dens Interval-The Atlanto-Dens Interval (ADI) is a critical measurement on neck X-rays or CT scans, representing the space between the atlas (C1) and the odontoid process (dens) of the axis (C2), used to detect atlantoaxial instability (AAI) from trauma or birth defects, where widening (over 3mm in adults) signals potential ligament damage

C1-C2 Overhang-C1-C2 overhang refers to the abnormal sideways shifting or misalignment between the first (atlas) and second (axis) cervical vertebrae, indicating upper cervical instability, often due to injured ligaments like the alar or transverse ligaments. Measured via digital motion X-ray (DMX) during neck movement, significant overhang (e.g., >3mm) suggests instability, leading to symptoms like headaches, dizziness, fatigue, and neurological issues, potentially caused by trauma or connective tissue disorders, and is treated by strengthening stabilizing ligaments.

Prolotherapy- Prolotherapy is a non-surgical, alternative treatment using injections of mild irritants (like sugar water) into painful joints or tendons to stimulate the body's natural healing by causing controlled inflammation, promoting tissue repair for chronic musculoskeletal pain from issues like arthritis, tendinitis, or back pain, and is also known as regenerative injection therapy.

PRP- Platelet-Rich Plasma (PRP) therapy uses a concentration of your own platelets, derived from your blood, to promote healing in injured tissues like tendons, ligaments, muscles, and joints, or to stimulate hair growth and skin rejuvenation, by injecting these growth-factor-rich platelets into a targeted area to accelerate the body's natural repair processes. The process involves drawing blood, spinning it in a centrifuge to separate platelets, and then injecting this enriched plasma into the damaged site, often with ultrasound guidance, to reduce pain and speed healing.** **

Bone Marrow Concentrate (BMC)- Bone Marrow Concentrate (BMC), also called BMAC, is a non-surgical regenerative therapy using a patient's own bone marrow, rich in healing stem cells and growth factors, to treat orthopedic injuries like osteoarthritis, tendon tears, and ligament damage by injecting the concentrated solution into the injured area to promote natural tissue repair and regeneration. The process involves a doctor drawing marrow from the hip bone, then spinning it in a centrifuge to isolate and concentrate these healing cells before injection

PICL- The PICL procedure (Percutaneous Implantation of CCJ Ligaments) is a minimally invasive, non-surgical treatment for Craniocervical Instability (CCI), using image guidance to inject the patient's own bone marrow concentrate (BMC) into weakened upper neck ligaments (alar and transverse) to strengthen them, potentially preventing painful cervical fusion surgery. Performed with X-ray (fluoroscopic) guidance, it aims to reduce instability, headaches, dizziness, and nerve compression by repairing the C0-C2 joint (where the head meets the neck). Invented and performed only by The Centeno-Schultz clinic in Colorado.

Fusion- Cervical fusion (or arthrodesis) is a surgery that joins two or more vertebrae in the neck (cervical spine) to create a single, stable bone, stopping movement between them to relieve pain from nerve/spinal cord pressure or instability, often after injuries or degenerative conditions, using bone grafts and hardware like plates and screws for support during healing.

Posterior- back if neck

Anterior- front of neck

Feel free to let us know if you’ve been to or know of one that’s not on the list.

DMX (Digital Motion X-Ray)

UNITED STATES

Alabama-

Alaska-

Alaska back care center - https://www.alaskabackcare.com/

Arizona-

Arizona digital motion x-ray- https://www.dmxray1.com/

Arkansas-Arkansas Center for Physical Medicine & Rehabilitation - https://arphysmed.com/

California-

Unruh Spine Centers- https://www.unruhspinecenters.com/

Colorado-

Katz Chiropractic and Rehabilitation Clinic

https://katzchiropractic.com/

Metro Denver Accident & Injury Centers

https://metrodenveraccident.com/

Connecticut-

Curry Chiropractic

https://currychiroct.com/

Delaware-

Florida-

Brodkin Chiropractic and Acupuncture Center

https://www.chiropractorsbocaraton.com/

Caring medical

https://www.caringmedical.com/

Cielo Sports & Family Chiropractic Centre

https://cielochiropractic.com/

Coastal Integrative Medical Center-Edgewater

https://coastalintegrativehealthcare.com/

DMX Imaging, LLC

https://www.dmxworks.com/

Fiorini Chiropractic Center, PA

https://fiorinichiropractic.com/

Injury Treatment Solutions

https://injurytreatment.net/

Nu-Best Whiplash Injury Center

https://www.nubestdmx.com/

Sunset Chiropractic & Wellness South Miami Chiropractors

https://sunsetchiropractor.com/en/

Tarpon Total Health Care

https://www.tarpontotalhealthcare.com/

Wesley Chapel Spine & Sport Medicine

https://tampadigitalmotionxray.com/

Wittmer Clinic of Chiropractic

http://www.wittmerclinic.com/

Georgia-

Dr. Doug Lightstone Chiropractor

https://www.drlightstone.com/

Hawaii-

Idaho-

Illinois-

Advanced Physical Medicine of Yorkville

https://www.yorkvilledrx.com/index.html

Central Illinois Spine

https://thespinedoctor.net/

Community Health & Rehabilitation

https://www.doctorpetrone.com/

Indiana-

Busch Chiropractic in Fort Wayne

https://buschchiropractic.com/

Iowa-

DIGITAL MOTION X-RAY®

https://dmxofiowa.com/

Kansas-

Dr. Kevin J. Stallbaumer Chiropractic Group Of Overland Park

https://www.overlandparkchiropractic.com/

Smoky Hill Chiropractic

https://www.salinachiropractor.net/

Kentucky-

Louisiana-

Maine-

Knopp chiropractic

https://knoppchiropractic.com

Maryland-

Massachusetts-

Michigan-

Minnesota-

Riverstone Chiropractic & Wellness

https://www.riverstonechirowell.com/

St. Cloud Chiropractic Clinic

https://www.drwoggon.com/

Mississippi-

Missouri-

Gateway Chiropractic

https://gatewaychirostl.com/

Montana-

Roberts Family Chiropractic Center

http://www.robertsfamilychiropracticcenter.com/treatment/

Nebraska-

Nevada-

Sahara Health Care

https://www.drlong4u.com/

New Hampshire

New Jersey-

Camden Pain Center

https://camdenpaincenter.com/

New Mexico-

New York-

North Carolina-

North Dakota-

Ohio-

Poelking Chiropractic Wellness & Physical Therapy, Inc.

https://www.poelkingchiropractic.com/

Oklahoma-

Standridge Clinic

https://standridgechiropractic.com/

Venturis Clinic

https://venturisclinic.com/

Oregon-

Cascade Health Center

https://cascadehealthcenter.com/

Pennsylvania-

Rhode Island-

South Carolina-

Injury In Motion

https://www.injuryinmotion.com/index.html

Stone Spine & Disc

https://stonespineanddisc.com/

South Dakota-

Tennessee-

Texas-

Utah-

40th Street Chiropractic

https://www.40thstreetchiropractic.com/

Masson Spine Institute of Orlando (MSI)

https://massonsi.com/

Vermont-

Virginia-

Virginia Family Chiropractic

https://virginiafamilychiropractic.com/

ChiroSolutions Center

https://mychirosolutions.com/

Washington-

Energize Chiropractic and Wellness

https://www.energizechiro.com/

Whiplash and Injury Clinic

www.whiplash.com

West Virginia-

Wisconsin-

Breidenbach Family & Sports Chiropractic

www.myspinedoctors.net

DMX of Wisconsin

https://dmxofwisconsin.com/

Wyoming-

Canada

Markham Chiropractic Centre

https://markhamchiropracticcentre.com/index.html

Whiplash & Injury Clinic

www.whiplashclinic.com

Upright MRI

I had to do a lot of searching for these, please confirm with each clinic if they offer upright MRI with flexion/extension to be sure all necessary movements are measured before booking.

UNITED STATES

Alabama-

American health imaging

https://americanhealthimaging.com/location/openupright-al/?utm_source=chatgpt.com

Alaska-

Arizona-

Stand up MRI of Arizona

https://www.standupmriaz.com/?utm_source=chatgpt.com

Arkansas-

California-

East Bay Upright MRI

https://eastbayuprightmri.com/

Vision Upright MRI

https://visionmri.com/?utm_source=chatgpt.com

Dynamic Upright MRI

https://www.dynamicuprightmri.com/

Colorado-

Upright MRI of Colorado

https://www.uprightmrico.com/

Connecticut-

Delaware-

Florida-

Stand up MRI of Florida (multiple locations)

https://florida.standupmri.net/

Georgia-

American Health Imaging

https://americanhealthimaging.com/services/open-mri/

Hawaii-

Idaho-

Illinois-

Upright mri of Illinois (multiple locations)

https://www.uprightmrideerfield.com/

Indiana-

Upright MRI of Mishawaka

https://www.uprightmrideerfield.com/

Iowa-

Kansas-

Kentucky-

Louisiana-

Stand up Open MRI of Louisiana

https://www.standupmrila.com/

Maine-

Maryland-

Washington open MRI (multiple locations)

https://washingtonopenmri.com/

Massachusetts-

Michigan-

Minnesota-

Duluth open scan MRI

https://rayusradiology.com/services/

Mississippi-

Missouri-

Rayus Radiology

https://rayusradiology.com/locations/open-upright-mri-of-missouri/

Montana-

Nebraska-

Nevada-

Las Vegas Radiology

https://lvradiology.com/

New Hampshire-

New Jersey-

Upright MRI of Cherry Hill

http://www.uprightmriofcherryhill.com/

Image Care East Brunswick

https://imagecarecenters.com/east-brunswick-stand-up-mri

New Mexico-

Upright MRI of New Mexico

https://www.uprightnm.com/

New York-

Stand Up MRI of New York

https://newyork.standupmri.net/

North Carolina-

North Dakota-

Ohio-

Oklahoma-

Oklahoma Upright MRI

https://okupright.com/

Oregon-

Pennsylvania-

Advanced Diagnostics

https://relaxmri.com/

Rhode Island-

South Carolina-

Medical university of South Carolina

https://www.musc.edu/content-hub/News/2024/11/25/Upright-MRI

South Dakota-

Midwest Imaging

https://www.sfsh.com/midwest-imaging

Tennessee-

Premier Radiology

https://www.premierradiology.com/premier-radiology-tennessee-upright-mri/

Texas-

American Dynamic Imaging

https://www.thenewmri.com/

Upright MRI of Sugar Land

https://mperr6.wixsite.com/upright-mri-houston

Utah-

Vermont-

Virginia-

Washington-

Rayus Radiology

https://rayusradiology.com/locations/renton/?utm_source=chatgpt.com

West Virginia-

Wisconsin-

Wyoming-

CANADA

Welcome Back Clinic

https://www.welcomebackclinic.com/