Craniocervical Instability: Health Services

Craniocervical instability (CCI) is a complex presentation that can arise in the context of a range of underlying conditions. At present, there is no agreed national diagnostic definition or evidence base to support a distinct National Health Service pathway. This makes the development of a single national NHS pathway challenging. At present, clinical assessment and management are undertaken through existing recognised specialties, such as neurology, rheumatology, spinal surgery and pain services, based on the individual symptoms and needs of each patient.

The NHS has established safeguards to protect patients, including the requirement that any investigations or interventions offered within the health service must meet nationally accepted standards of clinical safety, evidence and value for money. NHS England supports clinicians through relevant professional guidance, and patients who have concerns about their care can raise these with their clinical team, local service providers, or through the NHS complaints process to ensure that issues are fully addressed.

Patient experience remains central to service development, and feedback gathered through clinical services, commissioners, and patient organisations will continue to inform work to improve care for people with complex connective‑tissue and spinal conditions. As the evidence base develops, the Department will continue to work with NHS England to consider how services for people with suspected CCI can evolve, including whether changes to pathways or models of care are warranted in the future to improve consistency, safety and patient experience.