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Characterizing Initial Cervical Spine and Neurovascular Findings in 84 Consecutive Patients with Hypermobile

Ross A Hauser1, Morgan Griffiths2, Ashley Watterson3

  • 1Caring Medical Florida, 9738 Commerce Center Court, Fort Myers, FL 33908, USA.

Journal of Clinical Medicine
|March 28, 2026
PubMed

Insights

Hypermobile Ehlers-Danlos syndrome (hEDS) patients often have cervical spine issues, including ligamentous instability and reduced vagus nerve size. Findings suggest potential internal jugular vein compression, contributing to multisystem symptoms in hEDS.

Area of Science:

  • Orthopedics
  • Neurology
  • Vascular Medicine

Background:

  • Hypermobile Ehlers-Danlos syndrome (hEDS) presents complex diagnostic and treatment challenges due to widespread symptoms and multisystem involvement.
  • Objective characterization of cervical spine and neurovascular findings in hEDS is limited.
  • Previous studies focused on upper cervical spine issues, but mechanisms for associated symptoms remain unclear.

Purpose of the Study:

  • To examine objective findings in the cervical spine and neurovasculature of hEDS patients.
  • To explore potential pathologies contributing to the clinical profile of hEDS.
  • To understand the link between cervical spine and neurovascular findings and hEDS symptomatology.

Main Methods:

  • Retrospective observational study of 71 hEDS patients (aged 20-50) at an outpatient neck center.
  • Data collected via chart review, excluding prior neck surgery or trauma.
  • Diagnostic tools included digital motion X-ray, cone beam CT, Doppler ultrasound, and tonometry.

Main Results:

  • Over 71% of patients reported ≥29 symptoms.
  • Nearly all patients showed forward head posture, decreased cervical curve depth, ligamentous instability, and reduced internal jugular vein (IJV) and vagus nerve cross-sectional area (CSA).
  • Vagus nerve CSA was significantly smaller; IJV CSA was smaller at C1 than C4-C5, indicating potential C1 carotid sheath compression.

Conclusions:

  • Cervical spine pathology, IJV compression, and vagus nerve degeneration are common in hEDS.
  • These findings may contribute to or be an etiological basis for multisystem involvement in hEDS.
  • Provides hypothesis-generating data for future mechanistic, diagnostic, and therapeutic studies in hEDS.

Keywords:
autonomic nervous systemcervical instabilitycervical lordosisforward headhypermobile Ehlers–Danlos syndromeinternal jugular veinvagus nerve

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