Using MRI to Measure CSF Flow in Patients with CCJ Instability

by Chris Centeno, MD /

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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8 thoughts on “Using MRI to Measure CSF Flow in Patients with CCJ Instability

  1. chris

    I was recently reading a research paper on zebra fish, and their genes involved in cilia control. When the genes were faulty, cilia along the spinal cord and higher stopped moving. Consequently the CSF in the spinal cord stopped flowing, and the fish developed severe curves in their spine. When the faulty genes were restored to normal, the CSF flow resumed and the curves went away. Obviously I am simplifying the paper, but the researchers are hoping it is a starting point for spinal disorders like idiopathic scoliosis.

    1. Regenexx Team Post author

      Chris,
      Interesting. I’ll check it out…

    2. Chris Centeno Post author

      Interesting Chris, can you post the link to the paper?

  2. Sharon Richardson

    I was fortunate to be treated by Dr Rosa in 2011…I have MS and had been treated for chronic cerebrospinal venous insufficiency (CCSVI) at Stanford in 2009. Knowing that I had fluid flow issues, I connected with Dr Rosa to inquire of his interest in imaging MS patients who had been treated for CCSVI (blockage of blood draining from brain through the internal jugular veins). He found that we all had mechanical issues at the CCJ which was not only disturbing the flow of CSF, but also affecting the blood flow to and from the brain. Women are at more risk to be affected because the neck structure is not as strong as the male.
    Dr Rosa will be publishing 3 case studies in 2017 which should be of interest to anyone with neurological disease.
    I am forever grateful to Dr Rosa for his interest in my grandson who upon Fonar imaging found that CSF was pounding into the back of his brain. It was a mis-alignment at the CCJ (probably caused during a traumatic birth delivery). Dr Rosa uses the dramatic pre and post
    images to show the CSF flow correction.
    Link to interview with Dr Rosa “How Does Craniocervical Misalignment Effect Fluid Flow in the CNS” https://www.youtube.com/watch?v=-n4wF0Ya1ps

  3. chris

    Sorry I took so long to post links. Forgot I made the comment. I need regenexx in the brain.
    https://www.princeton.edu/main/news/archive/S46/55/01I26/index.xml?section=topstories
    https://www.ncbi.nlm.nih.gov/pubmed/27284198

    1. Regenexx Team Post author

      Thanks Chris!

  4. Brian Morgan

    My wife traveled to Dr. Rosa in October of 2016 for this advanced imaging related to her Arno Chiari malformation. His imaging, adjustment, and post imaging clearly demonstrated the effect related to CSF flow. It was fascinating. Now we are learning more from Regenexx about the CCJ instability involvement as well. Hopeful for help! Thanks Dr. Centeno and Dr. Rosa. (And Dr. Hunt in Florida for connecting us with both! 🙂 ) We are blessed with some very intelligent caring medical specialists!!

    1. Regenexx Team Post author

      Brian,
      Thank you – Happy to help!

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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