Is traumatic C1 instability missed on static x-rays?

We just received an case study from the DMX company. DMX is a trade name for “Digital Motion X-ray” a technology that we have used in spinal injury cases in the past where C1 instability appeared likely due to the client’s symptoms. We are posting this because the video demonstrates something very interesting that insurance companies, defense lawyers and their defense expert witnesses will say cannot be the case to a jury, and we thought we should share this with the medical and legal communities so that they stop intentionally misleading juries.

If you are looking for a C1 instability lawyer, our law office has handled many C1 lateral instability cases. The injury occurs due to axial distraction of the neck during the initial phase of a motor vehicle impact, coupled with tearing of the structures that attach C1 to both the skull (occipital area) and the C2 vertebra. Common symptoms include some of the following:

  • A feeling that the head is too heavy for the neck to support;
  • Low grade, but chronic headaches that don’t go away after trauma despite treatment;
  • Dizziness with neck movement;
  • Blackouts with neck movement;
  • A “clunk” sound with neck movement (which differs from a chiropractic adjustment);
  • A “greying” out of vision (loss of color);
  • Tunnel vision (loss of peripheral vision);
  • Temporary Blindness; and
  • Other neurological conditions caused by vascular compromise including Postural Orthostatic Tachycardia Syndrome (“POTS”).

There are other symptoms, but these tend to be the ones that are more commonly associated just with C1 instability, and not mixed with other conditions.

As discussed elsewhere on this web site, symptoms occur due to an instability of the C1 vertebra leading to compression of the vertebral artery within the transverse foramen of the neck. The vertebral artery gets stressed and then compressed as C1 moves an abnormal amount, thereby shutting down blood flow from the vertebral artery into the brain. This in turn shuts down the blood supply to the occipital lobe which processes visual information in the brain. This lack of blood flow results in the visual symptoms listed above as well as Postural Orthostatic Tachycardia Syndrome and other conditions impacted by a lack of blood flow to the cranial nerves and posterior brain.

The injuries to the ligaments of the Craniocervical Junction and the resultant C1 instability are the subject of the new medical text “The Craniocervical Syndrome and MRI” published by Karger (2015). Despite this being well known, and published in both medical journals and textbooks, defense experts will almost always claim that the injured person has a personality disorder instead.

Doctor/Lawyer Aaron DeShaw is a C1 instability lawyer, who has lectured on this topic nationally and internationally for both doctors and lawyers. The medical literature suggests that post-traumatic C1 instability is due to Alar Ligament damage, Transverse ligament damage, or damage to the lateral capsules of C1.

As C1 instability lawyers, we have handled several trials involving clients with C1 instability and the consequences of that injury, including cases of traumatic POTS. Insurance companies and their expert witness doctors have testified that you can get the same information about lateral instability of C1 if doctors take normal x-rays (in the lateral APOM position) rather than doing a DMX study. This video demonstrates very clearly that is not the case. What video 1 in this DMX video shows, is a patient laterally bending with no apparent C1 translation to the right, a lesser amounts of translation to the left for the first two attempts. It is likely during these first two attempts that a static x-ray would be taken, leaving the radiologist (and thus the lawyers, the insurance company, and the jury) with the impression that there is no translation to the right, and a less abnormal translation to the left. But, take a look what happens to the motion on the remaining studies.

Insurers (and the defense lawyers and doctors they hire) will bring up issues of resolution of the DMX, and the fact that the same thing can be done with a higher resolution static x-ray, but this study shows quite clearly that this is not the truth. This study shows that unless you can see the spine in motion, you could easily mis-characterize this instability as being entirely normal.

Our firm has a C1 instability lawyer with a great deal of experience handling C1 instability cases and the neurological consequences of them. If you are an injured party, or a law firm with a client with a C1 instability seeking experienced co-counsel, feel free to call us for a free consultation at (503) 227-1233.


While Dr. DeShaw has lectured at DMX continuing education events in the past [because he believes this is useful technology in diagnosing injured people,] he has not in several years due to time constraints. DeShaw has no financial interest in the company at all, has not been paid anything for his lectures for DMX, nor does he get anything to post things like this. This information is being posted solely because we believe it provides important information to understand how to detect these injuries because C1 instability has significant long term effects for people with that injury. We believe it is important that they have doctors and lawyers who understand the injury, and how to detect it correctly. This study demonstrates that plain film x-rays may miss the injury all together, or understate the significance of the C1 instability.

About the

Aaron DeShaw is a personal injury lawyer at DeShaw Trial Lawyers, a law firm representing injured people with serious injuries including brain injuries and other catastrophic injuries. He has individually, and in association with other law firms, obtained over $1 Billion for his clients. Learn more about Aaron and the Firm.