Advanced non-surgical solutions for craniocervical instability.

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What is the PICL Procedure?

The PICL (Percutaneous Implantation of the CCJ Ligaments) procedure is a highly precise, direct injection of the CCJ ligaments including the alar, transverse, and accessory ligaments. The tectorial and PAO membranes can also be injected. The implantation part of the acronym refers to placing the patient’s own bone marrow stem cells into these ligaments to promote healing.

In order to reach these ligaments, the only safe route (that avoids the upper cervical spinal cord) is through the posterior oropharynx (back of the throat). To accommodate this, the patient is put to sleep using advanced anesthesia techniques and a specialized and custom 3D printed oral appliance is used to hold the tongue down and the airway open while allowing x-ray guidance using fluoroscopy.

This procedure is dramatically less invasive than upper neck fusion surgery with fewer complications. Its goal is to heal damaged ligaments rather than screwing together bones. At its heart, it’s a complex and technically demanding injection rather than an invasive open surgery. 

Surgery is not your only option…

The PICL Procedure offers a viable alternative to surgical intervention. Surgery has been shown to produce questionable results and introduce a myriad of problems and complications, as well as beginning a degenerative cascade of surrounding structures. By utilizing precise regenerative injection treatments, our goal is to help your body strengthen damaged ligaments and allow them to regain the control they are intended to have on the stability of the cervical spine.

Stem Cells and Ligament Healing

We use a same day stem cell procedure called “bone marrow concentrate” to implant your own stem and other cells into the damaged upper cervical ligaments. This involves a bone marrow aspirate in the morning where we take what looks like thick blood from the back of the pelvis area (PSIS). The site is thoroughly numbed and most patients only feel the numbing and then a strange pushing/pulling sensation.

Sedation is available, although most patients just have the area numbed and report that this procedure is much more comfortable than they expected. This bone marrow aspirate is then processed in our sterile hoods to maximize the stem cell yields. Finally, the finished bone marrow concentrate is injected into the target ligaments.

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