Understanding Invasive Cervical Traction (ICT) Results: How was the dynamic BDI 2mm threshold determined?

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im_so_tired

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3
I was recently diagnosed with Craniocervical Instability by Dr. Bolognese. All of my MRI measurements are normal, so the diagnosis is based entirely on the measurements from ICT. During ICT, the only measurement that was abnormal was the dynamic BDI, which indicates vertical instability. In the report, Dr. Bolognese says that a dynamic BDI of 1-1.5 mm during ICT is normal for healthy individuals and greater than 2 mm makes you a candidate for surgery. Since this measurement is the only hard finding for my diagnosis (I also had symptom improvement during ICT), I am very interested in how reliable/valid the 2 mm threshold is for diagnosing CCI. Are you aware of any published articles that discuss how the normal range and the surgical threshold were determined? I haven't been able to find any, which makes me concerned about basing the decision to get surgery largely on that one measurement.
 
M

MecfsPatient

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How great was your symptom improvement in invasive traction? I think Dr. B primarily uses the measurements to guide where your head needs to be placed with intraoperative traction in order for you to get relief. He mentions in a lot of talks that some patients can be very sick with imaging that looks mostly fine, and some can have horrible looking imaging but not have severe symptoms caused by those pathologies. So he bases a lot of the decision of whether you’re a surgical candidate on whether or not your symptoms improve during the ICT. I think he needs to see that measurement change because otherwise he would have no guide for where to fuse you. I agree it’s frustrating there’s so little research published on this. Dr. Kaufman and Ruhoy (who is the medical director of Mt. Sinai) have a paid podcast on Patreon and they have an episode on ICT but I can’t link to any articles.
 
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