Understanding the Craniocervical Junction: Anatomy, Safety, and Upper Cervical Chiropractic Care

As a PhD anatomist, I approach chiropractic care with a healthy skepticism, particularly concerning its safety around the craniocervical junction. The risk of stroke associated with cervical manipulations has been a topic of significant debate. However, it’s crucial to understand the anatomy of the blood vessels in this region and to recognize the safety protocols and gentleness of upper cervical chiropractic care. This blog post aims to elucidate these aspects and provide a balanced perspective.

Anatomy of the Craniocervical Junction

The craniocervical junction (CCJ) encompasses the occipital bone of the skull, the atlas (C1), and the axis (C2) vertebrae. This region is anatomically complex and houses critical structures, including the brainstem, spinal cord, and several major blood vessels.

Course and Pathway: The vertebral arteries originate from the subclavian arteries and ascend through the transverse foramina of the cervical vertebrae from C6 to C1. They then pass through the foramen magnum to supply the brainstem, cerebellum, and posterior part of the brain.

 Vulnerability: The vertebral arteries are most vulnerable to mechanical forces at the C1-C2 level, where they make a sharp turn to enter the foramen magnum.

Formation: The vertebral arteries merge to form the basilar artery at the base of the brainstem. The basilar artery supplies blood to the brainstem, cerebellum, and occipital lobes.

Course and Pathway: The internal carotid arteries, arising from the common carotid arteries, ascend the neck and enter the skull through the carotid canals. They supply the anterior and middle portions of the brain.

 Jugular Veins: The internal jugular veins are major brain venous drainage pathways. They run parallel to the carotid arteries and pass close to the CCJ.

Safety and Gentleness of Upper Cervical Spinal Care

Upper cervical chiropractic care, explicitly targeting the atlas (C1) and axis (C2) vertebrae, is distinct from general spinal manipulations. It emphasizes precision and gentleness, aiming to correct misalignments without forceful movements.

Precision and Imaging

Advanced Imaging: Upper cervical chiropractors use advanced imaging techniques, such as digital X-rays and MRI, to assess the precise alignment of the CCJ. This ensures that adjustments are based on accurate anatomical data.

Gentle Adjustments

Non-Forceful Techniques Unlike traditional spinal manipulations that may involve twisting or high-velocity thrusts, upper cervical adjustments are performed with minimal force. These gentle corrections are designed to reposition the atlas and axis without stressing the surrounding structures.

Safety Protocols

Training and Certification: Upper cervical chiropractors undergo specialized training and certification, focusing on the unique anatomy and biomechanics of the CCJ. This training enhances their ability to perform safe and effective adjustments.

Incidence of Stroke and Upper Cervical Adjustments

The concern about strokes related to cervical manipulations, precisely vertebral artery dissections, is valid but often overstated. Research indicates that the incidence of stroke following an upper neck adjustment is approximately 1 in 3,000,000 adjustments. This rate is comparable to, or even lower than, the risks associated with other standard medical procedures.

Risk Factors

   – **Underlying Conditions**: Most cases of stroke following cervical manipulation are associated with pre-existing vascular abnormalities or connective tissue disorders. Screening for these conditions is a standard practice in upper cervical care.

Comparative Safety

Medical Procedures: The risk of serious complications from upper cervical adjustments is significantly lower than many routine medical interventions, underscoring the relative safety of this approach.


Understanding the anatomy of the blood vessels around the craniocervical junction is essential in evaluating the safety of upper cervical chiropractic care. The precise and gentle nature of these adjustments, combined with rigorous safety protocols and advanced imaging, significantly mitigates the risk of adverse events, including stroke. With an incidence rate of approximately 1 in 3,000,000 adjustments, upper cervical care is a safe and effective option for addressing misalignments in this critical region.

Consulting with trained and certified practitioners who prioritize patient safety and utilize evidence-based practices is essential for those considering upper cervical chiropractic care. As our understanding of the craniocervical junction continues to evolve, so does our ability to provide safe and effective care for patients experiencing spinal and neurological issues.

Schedule your No Obligation Consultation with Dr. Lea!