Using MRI to Measure CSF Flow in Patients with CCJ Instability

POSTED ON 12/16/2016 IN Research BY Christopher Centeno

Brain and Cervical CSF Flow MRI


We will learn more about the human neuromusculoskeletal system in the next few decades than we have learned in the last several hundred years. If you need proof of that, just take a look at some truly inspired technology being used in upstate NY by Scott Rosa and Dave Harshfield. Dr. Rosa and I have worked on many patients together that have CCJ instability. Dave Harshfield, M.D. is a veritable walking encyclopedia on imaging the body. Between the two of them, they're pioneering what we know about how the CSF flows around the brain and how best to measure this phenomenon. Let me explain.

What Is the CSF?


Cerebrospinal fluid, or CSF, is the liquid that bathes the brain and the spinal cord. It serves as both a cooling system and waste-removal mechanism. It also supplies nourishment to the brain tissues. There have been many diseases postulated to occur because of poor CSF flow, including multiple sclerosis and Alzheimer's. The CSF is pumped by the body, so when imaged it appears to flow like blood. We've never had the ability to image CSF flow around the spinal cord and back and forth to the brain. The issue is that MRI technology doesn't handle movement well. However, the company Fonar that makes a stand-up MRI has been working with select physicians around the country to develop protocols for measuring CSF flow. In fact, the company has been working with NASA on the issue of disturbed CSF flow in astronauts, which was recently in the news.

What Is CCJ Instability?



Your head is attached to the upper spine by very tough and strong ligaments. These can be damaged in certain types of trauma, including car crashes or when there's a blow to the head. These patients can get significant dizziness, headaches, facial symptoms, disorientation, and so on. We have invented a novel therapy to treat these ligaments and have had good results. To learn more about this issue, see the video.

MRI That Can See the CSF Flow



I first saw these amazing pictures a few years back at a conference. The more I worked with Dr. Rosa and Dr. Harshfield, treating their patients with CCJ instability using our novel stem-cell-based injection technique, the more of these images I've reviewed. So I wanted to show my blog readers just how cool these look. Note that in this video, the left image is before a specific upper cervical adjustment performed by Dr. Rosa, and the after image is after that procedure. Also, note that what you're looking for is the pulsing black or dark fluid that's moving around the grayed-out brain and spinal cord. The video discusses where you see the changes. Most importantly, these changes are seen before and after chiropractic care! The implications of this technology are interesting. First, it can apply to patients with significant CCJ instability. Why? One of the problems for many physicians trying to get their head around this diagnosis is that there are large amounts of space around the spinal cord in this part of the spine. Hence, even significant amounts of instability in the upper neck do not necessarily damage the spinal cord in the same way that a small and arthritic spinal canal can compress this structure at a lower level of the neck. So what does happen? First, based on these images, even small amounts of motion disturbance in this region can apparently reduce CSF flow. When the upper neck bones are allowed to move more normally after specific manipulation, the CSF flow improves. Also, the sensitive covering of the spinal cord called the dura can also be irritated along with cranial nerves and the vertebral artery in this region, all leading to serious problems. This technology can also be used to measure CSF flow disturbances due to cervical stenosis. This condition is where the spinal cord can become pinched or compressed by neck arthritis. Also, with new research showing that CSF flow may be related to how or why Alzheimer's disease develops, we may see that disturbances in this movement of CSF are important for prognosis and diagnosis. The upshot? As I said, we will learn more about how our bodies really work in the next few decades than we've learned in the past few hundred years. This is an exciting time, and I applaud the work of pioneers like Dr. Rosa and Dr. Harshfield!  

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