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.
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.
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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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…