Kyphosis, Stenosis and Multiple Sclerosis

The spine has four curves. Two of them curve forward toward the belly side of the body. They are the cervical (neck) and lumbar (low back)  spines. The other two arch backward toward the back and buttocks. They are the thoracic spine which supports the ribcage, and the  sacrum which sits in the back of the pelvis beneath the low back. It is the pedestal the spine rests on and, similar to the thoracic spine, bends backward to support a load.

The term kyphosis refers to the normal curves of the thoracic spine and sacrum.  It also refers to an exaggeration of the thoracic curve that causes a pronounced hump or backward bend in the upper back called a Gibbus deformity that pitches the shoulders and neck forward of the normal gravity line. Exaggerated kyphosis also causes a loss in height. In severe cases it can interfere with breathing as it alters the rib cage which contains the lungs and heart. Exaggerated kyphosis is sometimes referred to as hyperkyphosis.

The term kyphosis can also be used to describe an abnormal curve of the spine that goes in the opposite or wrong direction.  For example, it can be used to describe a reversal of the curve in the low back. More commonly, it is used to describe a reversal of the normal curvature in the cervical spine, which is the neck. The x-ray on the right is a good example of a kyphotic (backwards) curve in the cervical spine. Kyphosis occurring in any area of the spine can be inherited as a developmental design problem or it can be acquired later in life through trauma, aging and diseases such as arthritis, osteoporosis, compression fractures and Parkinson’s disease.

Scoliosis is an abnormal lateral (sidewards) curve of the spine. Scoliosis is sometimes associated with kyphosis and is referred to as kyphoscoliosis. Scoliosis is typically a problem that becomes apparent in childhood. It affects females far more than males. Adults, however, can acquire scoliosis later in life due to trauma, degenerative conditions of the spine, inherited and acquired connective tissue disorders and other causes.

Scoliosis has been shown to cause functional stenosis of the spinal canal and subsequent compression of the vertebral veins which decreases venous blood flow. The problem occurs as the veins get compressed against the inside curvature of the spinal canal. Kyphosis most likely causes functional stenosis of the spinal canal and vertebral veins similar to scoliosis.

The images below are used with permission from a member of the TiMS website who underwent testing for chronic cerebrospinal venous insufficiency (CCSVI). The patient was found to have impingement of both internal jugular veins which was corrected by the placement of stents. Subsequent to placement of the stents the patient had considerable improvement in signs and symptoms.

The image is composed of three different views superimposed on one screen. The view to the left is a plain view x-ray of the upper back and neck. If you look closely at the spinous processes (they look like teardrops that go down the middle of the spine) you will see that they deviate to the left side of the spine. Likewise, if you follow the contour of the sides of the spine you will see that the spine is curved to the left. Since the x-rays were taken from front to back the left side of the film is the right side of the patient.

The middle image is a venogram which is an MRI with contrast dye injected into the veins. In this case, the red arrow points to an area of impingement or stenosis of the internal jugular veins just in front of the upper cervical spine. The impingement decreases blood flow through the internal jugular veins, which can back up in the brain.

The image on the right is an x-ray of the stents that were inserted using interventional radiology. More often, most physicians doing the procedure use venoplasty in which a balloon is inserted into the vein and then filled to stretch the vein and open it up. Venoplasty is subject to restenosis. Stents are tubes placed in the veins that spring outward to keep the veins open. Stents are more durable and less likely to re-stenose but pose more problems due to clots. In cases such as the one above it is a tough choice, but if the structural problem causing the impingement is permanent then durability may become more of a factor to consider in choosing procedures.

If you look closely at the above image to the right and follow the contour of the spine you will notice that it arches backwards slightly. As mentioned at the start, the neck or cervical spine should arch gently forward toward the chin. In this particular case the cervical spine is kyphotic or going in the opposite direction that it should.

The internal jugular veins exit the skull through the jugular foramen on the floor of the skull just in front of the transverse process of the C1 vertebra of the upper cervical spine called atlas. After exiting the skull the internal jugular veins join the external jugular veins and follow the curve of the cervical spine on their way down from the head and back to the heart. In the case above, the internal jugulars like the cervical spine bend backward due to the cervical kyphosis. This causes a sharp change in the course of the normal direction of blood flow out of the brain as the internal jugular veins bend around the upper cervical spine. In addition to possibly impinging the internal jugular veins where they exit the skull in front of the transverse process of C1 (atlas), kyphosis most likely compresses the vertebral veins on the inside curve of the cervical spine similar to what scoliosis does in the rest of the spine. Kyphosis and scoliosis most likely play a significant role in CCSVI and CCVBP.

The angle of the upper cervical spine to the base of the skull is important to blood and CSF flow going into and out of the brain and cord. Likewise, the relationship of the base of the skull and upper cervical spine to the curve in the lower cervical spine is important to blood and CSF flow. Inherited and acquired misalignments and disorders of the upper cervical spine, as well as spondylosis (degeneration), scoliosis and other abnormal curves including kyphosis affect blood and CSF flow to the brain and cord. They also cause malpositioning and thus mechanical stress and strain of the brainstem and cord within the skull and spinal canal.

For further information on the upper cervical angle visit my website.

http://www.upright-health.com/upper-cervical-angle.html

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About uprightdoctor

I am a sixty year old retired chiropractor with considerable expertise in the unique designs of the human skull, spine and circulatory system of the brain due to upright posture, and their potential role in neurodegenerative diseases of the brain and cord. I have been writing about the subject for well over two decades now. My interests are in practical issues related to upright posture and human health.
This entry was posted in ccsvi, chiari malformations, demyelination, Ehlers Danlos Syndrome, liberation procedure, ms lesions, multiple sclerosis, spondylosis. Bookmark the permalink.

17 Responses to Kyphosis, Stenosis and Multiple Sclerosis

  1. Elle says:

    This is interesting info for me as I have MS for 21 yrs. still ambulating but use a cane, actually 2 canes now due to imbalance and more weakness due to hot, humid summer. I was told by chiropractor I have scoliosis. I’m sixty and will be fitted next week for this new trial for me. Goggle Spinecor and you will see the apparatus. Any opinion from you? Thanks Ellen edrury22@hotmail.com

  2. Kelly taglarino says:

    Can a poor Csf flow in spine from degeneration cause dementia symptoms?

    • Hi Kelly
      It is my theory that poor CSF flow can lead to an increase in CSF volume in the brain and a condition called normal pressure hydrocephalus (NPH). NPH has been associated with dementia, Alzheimer’s and Parkinson’s disease. In fact it it the subject of my book “The Downside of Upright Posture – The Anatomical Causes of Alzheimer’s, Parkinson’s and multiple sclerosis.”

  3. Shirley says:

    Hi there! I am a 38 yr old female with kyphosis (Sheurmanns disease) in the upper thoracic region of the spine, and a mild scoliosis in the lumbar spinal region. When I was 12 yrs old, I experienced what I can only describe as an “electric shock” up the back of my neck and into the base of my skull which left the whole left side of my body paralysed for about 10-15secs, with no vision either in my left eye during this episode. I dont even think I told my parents at the time, as once the episode passed, my neck was tender and I was a little disoriented, but I eventually came back to normal over the course of the day. I suffered muscle spasms during my teens and had to take to the bed with valium and hot water bottles. I suffer chronic fatigue and musculo-skeletal pain constantly and inflamation of the joints sometimes after physical exercise, even during my twenties, having had glandular fever at aged 17.

    A year ago, I woke up with what I thought was a migraine up the right-hand side of my head, neck and face. I received anti-inflammatory injections from my doctor when migraine was ruled out, and physiotherapy for a spasm at the base of my skull rhs. I had an mri of the c-spine which only revealed early signs of degenerative disc disease. I have constant pins and needles and tingling in both my hands and feet, buzzing sensations up through my feet, jittering legs, muscles spasms, nerve pain in my shoulder and down my right arm, vertigo, blurring of vision in right eye, and episodes of “sun-burn” like patches on my skin which are very hot. I have stabbing pains in my head a lot and my skin itches constantly too.

    I am on omesar plus 20mg for uncontrolled post-partum bp for the last 7 yrs, and I take 20mg of cipramil (citalapram) for anxiety depression. I have had a cholocystectomy a year ago. Other than that, I am just living on pain killers and diphene tablets. Lately, I have swelling of the face and neck and enlarged glands, particularly the one under my left ear. Routine bloods have been carried out and all appears fine (also check for rheumitoid arthritis which came up negative). The only bloodwork I am waiting on is a full blood count on account of the swollen and enlarged lymph nodes in my neck and face. Sorry for the essay, but I am NOT a hypochondriac and have been living with a lot of pain now for some years. Could all this be simply down to my spinal deformities, or could I have a neurological disorder like ocipital/fibro myalgia or even MS, or could my medications be causing some of these debilitating symptoms? I know my meds could not be causing ALL of my symptoms, as I have suffered many of these before I started any long-term meds at aged 32.Any advice or information would be much appreciated.

    • Hello Shirely,
      I discuss the role of kyphosis and scoliosis in multiple sclerosis and conditions such as yours in my book. Abnormal curvatures of the spine affect the position of the cord and brain inside the cranial vault and spinal canal. They also compress the epidural space. The epidural space contains the vertebral veins, which are used to drain the brain in the upright position. Obstruction of venous flow in the brain and cord in turn affect cerebrospinal fluid flow in the subarachnoid space of the brain and cord. The disturbance in fluid mechanics increases pressure acting on the cord even when there is no apparent stenosis. Kyphosis can also affect blood flow through the vertebral-basilar arteries which supply the brainstem, which would explain the migraine symptoms. The foward position of your head due to the kyphosis is most likely compressing the space in the behind the cord in the thoracic spine thus increasing pressure on sensory tracts. This would explain the pins and needles etc. in your feet. The kyphosis is also most likely pulling the ventral (belly) side of the cord up against the clivus portion of the base of the skull. This would compress motor (muscle) tracts in the cord and explain the jittery legs and spasms. Furthermore, I suspect that the displacement of the brain in the cranial vault is the cause of your vertigo and blurry vision. Lastly, scoliosis and kyphosis affect the muscles and connective tissues of the shoulder and neck as well as the thoracic outlets, which would explain the symptoms the shoulder and right arm.

  4. Shirley says:

    Thank you so much for your prompt response to my queries. I will definitely give your book a read. I would love to have an official “diagnosis” for what I’m suffering, as then maybe I could take appropriate medication to give myself some form of relief or quality of life. Could you possibly make any suggestions about how I could follow up on this medically? Thank you.

    • Drs Flanagan says:

      Hello Shirely,

      Drugs may help alleiviate some of your symptoms but you need physical medicine to work on the structural problems in your spine (kyphosis and scoliosis) that ae causing the problem.

      You can purchase my book through my website. Purchase of the book includes my email address and a complimentary consultation.

      http://www.upright-health.com/Upright-Doctor-book.html

      Dr. Flanagan

  5. titan says:

    I am 46 and have multiple sclerosis. I also have kyphosis. The pain has become severe in the last year. What can you suggest besides fusion? Did kyphosis cause m.s. or m.s. cause kyphosis?

    • Hello Titan,
      I apologize for the delayed reply but they no longer get posted when I reply via my inbox. In regard to you comment and question, it is my opinion that abnormal curvatures in the spine such as scoliosis and kyphosis can cause neurodegenerative conditions and subsequent diseases such as multiple sclerosis. Abnormal curvatures of the spine affect blood and CSF flow in the brain and cord. They also cause abnormal displacements of the brain and cord inside the cranial vault and spinal canal. Among other things, displacement of the brain in the cranial vault can cause a Chiari 1 type malformation resulting in blockage of blood and CSF flow through the foramen magnum and upper cervical spinal canal. Before considering surgical fusion you should try manual therapies first. In cases such as yours, I used craniopathy and sacrooccipital technique (SOT), as well as mechanical and manual cervical and intersegemental traction. Specific upper cervical correction is also a good option as is the Cox 7 spinal decompression or similar table with the full feature cervical headpiece. You also need to find a good doctor who knows how to use the table appropriately for conditions such as yours.

      Dr. F

  6. justincamp says:

    Is multiple sclerosis genetic.

  7. debeejc says:

    Why would making corrections to the spinal alignment cause my MS syptoms to WORSEN? Or is this a coincidence? My head is now corretly placed on top of my spine, since Aug 2012, thanks to a local Chiro. trained in Atlas Orthogonal treatment.

    • debeejc says:

      Debeejc forgot to say that I have had 3 CSVI procedures. The last 2 Dr. Arat was trying to go into my left IJV, first from the Bottom up, then from the Top down, but not result. My left IJV is totally occluded. That was Spring 2011 and since then I am going downhill FAST. I soon will become bedridden as I cannot lift my legs. My last hope is Dr. Hernandez’s surgery(he is a Vascular Surgeon board certified in CA), now in Tijuana where he takes your saphenous vein and makes an alternate IJV with it. I am scared but see no alternative.

      • You can’t solve all the blood and CSF flow problems in the brain with jugular venoplasty or upper cervical adjustments for that matter. Nor will those procedures correct degenerative problems in the lower spine that may be effecting your condititon. You clearly have other issues. You need someone to go through your case hisory and exams findings very carefully.

    • Hi Debeejc,
      It’s easy to imagine how Atlas Orthogonal or any upper specific cervical method may not work in many cases due to a host of issues to numerous to mention here. It is hard to imagine how aligning the foramen magnum and upper cervical spine could possible make you worse. You havn’t given me enough information. You may have other problems.

  8. Mary says:

    My son is 26 years old and has been diagnosed within the last few years with kyphosis, scoliosis, and c4-c5 disk space. He is in prison and all they will do for him is give him ibuprofen and tylenol. He is in a lot of pain. Is there anything I can recommend for him to do? He is limited because of his circumstances. I have a cousin that had MS. I have been concerned that my son would develop it. Is this very likely?

    • Hello Mary,
      There is nothing to indicate that your son will get MS. Although they can be predisposing factors, most people with kyphosis, scoliosis and spondylosis, such as decrease in C4/5 disc space, don’t get MS. It depends on many factors, such as what caused the deformation of the spine. In my opinion, trauma is a major cause of MS. Under the circumstances, the best thing for your son to do is regular warm ups and mild pain free stretches of the entrie spine starting at the top with the neck and working his way down doing foward and backward bending, left and right side bending and left and right rotation. Since he is in pain, he should start gently or he will further irritate the muscles and joints. He should also try ice on the areas of pain or pain salves if they are permitted and available. Again, if they are available, some food seasonings and other condiments are antiinflammatory and circulatory tonics, such as ginger, turmeric, thyme, pepper etc., if they are avaiable. Fruits are also antiinflammatory.

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