Cervical Spondylosis and CSF Flow in the Cisterns

The brain is surrounded by a watery substance called cerebrospinal fluid (CSF), which is produced in chambers called ventricles located in the middle of the brain. In the MRI image on the right, the brain is white and CSF is black. The CSF pathways for the most part are smooth and there are no obstructions.

CSF  volume and pressure in the brain change with the contraction and relaxation cycles of the heart. When the heart contracts, a large volume of blood in the arteries is driven into the brain. To compensate for the increase in arterial blood volume a proportionate amount of venous blood and CSF is squeezed out of the cranial vault and into the spinal canal.

The outflow of blood and CSF is affected by the design, dimensions and alignment of the foramen magnum in the bottom of the skull and the spinal canal of the upper cervical spine. Many inherited (genetic) and acquired conditions of the base of the skull and upper cervical spine can decrease blood and CSF flow through the foramen magnum and upper cervical spine. Inherited conditions include: Arnold-Chiari malformations, Dandy-Walker syndrome, craniosynostosis, Klippel-Feil (fused cervical segments) occipitalization (fused upper cervical spine and skull), as well as others.  Aquired conditions include aging and injuries. Aging causes muscles, bones and connective tissues to degenerate, which can affect the tunnels nerves and blood vessels pass through. Injuries cause similar problems and hasten degeneration associated with aging.

Cervical spondylosis is a general term used to describe degenerative conditions of the cervical portion of the spine. Spondylosis can also occur in the thoracic and lumbar spine as well. All forms of spondylosis affect the design, dimensions and alignment of the spinal canal. The spinal canal is a tunnel that contains the spinal cord. It also contains arterial blood vessels that supply the spinal cord with fresh oxygenated blood and the verebral venous plexus, which is a dense network of veins, that drains the spinal cord and brain. The remainder of the space is filled with loose fat.

After passing through the foramen magnum and spinal canal of the upper cervical spine, venous blood and CSF that has been squeezed out of the brain during contraction of the heart and exhalation must flow through the lower cervical spinal canal. In the picture above on the left the brain is black and CSF is white. If you look closely at the cervical spine you will notice that the spinal canal is constricted due to spondylosis. In medical terms it is called stenosis, which means narrow. The cause of the stenosis in this case is spondylosis (degeneration of the spine).

In a previous post called CSF, Cisterns, Clapotis and Cysts, I discussed seawalls and standing waves called clapotis. The picture on the right is of Thunder Hole in Acadia National Park off the coast of Maine in North America. Over time the ocean eroded the shoreline and formed a tight canal. The water speeds up as it passes through the tight canal and crashes into the wall at the end causing it to sound like thunder and shoot straight up into the air.

Alterations in the design and dimensions of the lower cervical spine such as from cartilage and connective tissue degeneration can affect blood and CSF flow in the spinal canal similar to land masses that jut out into rivers. Land masses and seawalls reflect incoming waves that then travel back out to sea. When they meet up with another incoming wave the two combine and form a standing wave that is twice the size of the individual waves.

If the design and dimensions of the cervical spinal canal are correct, the blood and CSF will flow smoothly with little resistance. If the path is obstructed by cervical spondylosis (degeneration) their flow will become turbulent. If it becomes sufficiently restricted and turbulent it will cause back pressure and standing waves to form in the brain. Overtime, standing waves can tear apart shorelines. They can similarly damage the brain.

The first areas to receive the brunt of the standing waves are the basal cisterns of the brain. The cisterns are dilated pouches in the subarachnoid space in the outer coverings of the brain. The cisterns are filled with CSF and protect the brain from contact with bones of the base of the skull. The subcompartment in the base of the skull, called the sella turcica for the pituitary gland is also affected. An increase in CSF volume and pressure in the cisterns and sella turcica can cause problems in the brainstem and pituitary gland. It may also explain why some patients with neurodegenerative diseases have problems with the autonomic nervous system referred to as dysautonomia.

Standing waves may play a role in Dandy-Walker syndromes, Arnold-Chiari malformations, arachnoid cysts, empty sella syndromes, multiple sclerosis, Parkinson’s disease, Shy-Drager syndrome, Alzheimer’s disease and other neurodegenerative conditions.

For more information on spondylosis visit my website http://www.upright-health.com/cervical-spondylosis.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 Alzheimer's, arachnoid cysts, chiari malformations, CSF, Dandy-Walker syndrome, empty sella syndrome, multiple sclerosis, Parkinson's, spondylosis and tagged , , , . Bookmark the permalink.

17 Responses to Cervical Spondylosis and CSF Flow in the Cisterns

  1. Pedro says:

    What your saying makes perfect sense in regards to MS, but then why does stem cell therapy seem to halt or even reverse MS?

  2. Jeff says:

    Dr F, Your site on neuro disorders is mega-informative…actually overwhelming. I am a 46 year-old PD patient with a history of cervical spine injury. Neurologist says neck problem is cervical dystonia and unrelated to sports injury suffered in 1982 at age 17 (neck has been twisted/deformed/lopsided since the injury). Also says neck issue unrelated to PD dx. I feel differently. Believe there is associated explanation and applicable treatment other than PD meds (which Im not taking). Would like to run total health scenario by you for an opinion about CSF and how it may relate to my condition. What is your preferred method of info exchange? Thanks, JN

  3. Hello I am a 51yr old F that has just discovered by MRI the empty sella n my head. 5yrs ago @ 45yrs I got hurt on job multiple ruptures in cervical spine C3-4 4mm, c5-6 5mm, c6-7 9mm 6mm into spinal cord In extention. MRI also stated that there was myelomalacia more likely edema. and 2cyst on tyroid.76 WC denied claim and left it for 27mos. pain and paraesthesia from shoulders to toes was horrific. Total numb in certain areas disreqarded by ortho surg. I had acdf 34mm plate c5/6-c6/7 10/1/10 surgeon straighten lordosis c3-4 now only 2mm. When I awoke the only pain was only were incision was. Great! had ringing in ears for months and no bowel movement for 9 days. 3 weeks prior to surgery I had bp of 237/118 and horrible abdominal pain in ct they found ill defined left kidney and free fluid around the right kidney. unknown cause. last year I had an enlarged heart left vent malfuntion and unregulated bp, electrolyte imbalance,they gave me cozzar and in eight days caused muscle breakdown nearly did me in. than cbc was too high rdw. in four months my cholesterol jumped from 283 to 484 my b12 was high, also 4 mos ago they found cyst on my liver and for the last 7 months I am seeing triple vision and dizzy. I have done the alot of reasearch I get it I am a hot mess. I do not drink my body doesn’t like medications cause bile stent from 6 years ago.I only have the bs of work comp doctors and now going to County hosp. cause Something is majorly wrong.
    what can you tell me to tell the neurologist I see later this month all dr seem to get over whelmed when I hand them the medical records mri reports and blood work bp ambltory study. can you help me comunicate better?
    Thanks for your time.
    DR wilson

    • Hello Renee,
      I apologize for the delayed response. You have a complicated case. From what I gather, your current signs and symptoms include: empty sella syndrome, tinnitis, triple vision, unregulated hyertension, dyslipidemia, dizziness, cysts on the thyroid and liver, and edema around the right kidney and an ill defined left kidney. The grossly unregulated BP and sudden significant jump in cholesterol most certainly needs to be investigated further. Chronic unregulated hypertension is an known cause of left ventricle of the heart. The cysts on the liver and thyroid, the swelling around the right kidney and the ill defined left kidney require further investigation. The kidney issues may likewise be a consequence of the chronic unregulated hypertension. The surgery to repair the disc herniations most likely adversely affected the normal biomechanics of the upper cervical spine. Malformations, deformation and misalignments of the upper cervical spine can affect blood and CSF flow going in the brain. They can also cause displacement of the brain inside the cranial vault which is called ectopia. Among other things, it can cause intracranial pressure problems. Empty sella is a potential sign of increased intracranical pressure. The unregulated BP and cholesterol may be signs of dysautonomia and endocrine dysfunction due to increased intracranial pressure. An upright MRI and cine CSF flow study would be helpful to check for cerebellar tonsilar ectopia (CTE), as well as signs of increased intracranial pressure. Ectopia is a term for displacement of tissues. Displacement (ectopia) of any of the parts of the brain inside the cranial vault can strain blood vessels and nervers as well as attachments of the dura mater to the vault. Due to their location, the optic nerve for sight, the muscles that control the movement of the eyes and pupils, and the vestibulocochlear (acoustic) nerves are particularly susceptible to displacement (ectopia) faulty hydraulics in the cranial vault. You need an neuroradiologist with expertise in upright MRI and the craniocervical junction.

      • THANK YOU SOOO MUCH! I see the neurologist on Monday. Well go from There.
        I knew something was wacky….lol…Will stay in touch…Thank you…May God Bless you and yours!
        Renee

      • DarekMD says:

        You wrote so many quackery here!. Any respected neuroscientist will say that, that its why chiroparctors are called quacks(and its right) first show one study which confirm what you wrote here.

      • Hello Dr. Darek,

        Sorry for the delayed response.

        You can begin your education by reading a paper I published recently that includes hundreds of citations by neurosurgeons and radiologists to support what I am saying.

        I will also be publishing a book later this year on the role of craniospinal hydrodynamics in disorders of the brain and cord. It’s based on thirty years of work. I hope you are a fast learner. You will obviously need it to get up to speed with the science since you don’t seem to grasp the explanations I provide here for laypeople. As far as quacks are concerned there are far more fraudulent, phoney and dangerous doctors in medicine. In fact, medical doctors and medical care is one of the leading causes of death. Despite significant findings of neurodegenerative diseases such as dementia, Parkinson’s and ALS in boxers, NFL players and professinal socceer players, as well as the long suspected connection of MS to trauma, especially whiplash, most medical doctors still can’t see the obvious connection. It’ time to take the blinders off. It’s so simple you don’t need a medical degree to understand it. It’s often easier for me to explain basic craniospinal hydrodynamics to plumbers than medical doctors like yourself. It’s simple common sense physics.

  4. hi again I forgot to say that behind the 34 mm at c5 thru c7plate the is Spinal cord compression from c2 to T1 was found 15 months ago.sorry! I am scared of my own body at this point.

  5. Hello Again ….just wanted you to know that the Neurologist has given me 3x/300 Gabapectin confirmed the periphial neuropathy and ordered a Lumbar puncture on the 11/4. to find the cause…Than we shall see?

  6. Hello, Well the lumbar puncture was friday. The Manometer pressure was 38. so they filled all the bottles from the kit. Saw neurologist today and she is saying it is a pseudotumor cerebri gave me Rx Diamox said the optic nerves may need a neuroopthamologist and see the Neurosurgeon again in 3 months.
    So they drained my brain and gave me a pill and sent me home… the Labs have some ups and downs. Rare WBC no organisum seen…. WBC<5..(in csf)..Blood labs are chloride 110 high rdw high15.2..folate high 38.2…everything else seems to be in normal levels
    I am so confused on why they won't find out what caused the intercrainal hypertention and empty sella …and how it relates to the Cervical spine ….very frustrating… NO CT NO EMGS NOTHING??? why did my spinal fluid multipy so much…

    • Hello Renee,
      As I mentioned previously, the surgery to repair the disc herniations most likely adversely affected the normal biomechanics of the upper cervical spine. Malformations, deformation and misalignments of the upper cervical spine can affect blood and CSF flow going into and out of the brain. You need an upright MRI and cine CSF and blood flow study to check for cerebellar tonsilar ectopia (CTE). Moreover, you need a neuroradiologist with expertise in imaging the craniocervical junction and upright MRI. I would discuss it with the neuroophthamologist or neurosurgeon. In light of your condition, the MRIs are non-invasive, safe, very useful and relatively inexpensive.

  7. Claus Christensen says:

    Hi, thanks for all the great articles on the subject. Would you think stenosis in the upper cervical area or spondylosis could cause a wbc of 47 in the CSF ?

    • Hello Claus,

      Your welcome. WBCs in CSF is ususally due to infections,inflammation or an autoimmune-inflammatory condition. Typically, however, you would have other signs and symptoms of infection, inflammation or an autoimmune inflammatory conditions. It is possible that stenosis in the upper cervical spine could be causing or contributing to inflammation.

      • Claus says:

        thanks for the quick reply! Yes, in connection with mild spondylosis in a number of vertebra (cervical and thoracic) I also have sensory problems, tense muscles etc. Doctors tell me the wbc and two intramedullary lesions are signs of sclerosis. VEP was negative but SSEP confirmed that there is indeed an inflammation in the spinal cord. However, I feel convinced that my many years of back problems (I have a slipped disc by S1/L5 and two protrusions at C5 and C6) are the cause of the inflammation in the spinal cord. And not MS. But good to know that you tell me that the cause of intramedullary inflammation could be the back problems…Getting a neurologist to believe that is a whole different matter.
        thanks again!

      • Your welcome. It is highly unlikely that the slipped disc at L5/S1 or the disc protrusions and C5/6 and C6/7 are causing the increase in WBCs in the CSF. The presense of WBCs in CSF and intramedullary lesions are highly suspicious signs of inflammation and possible sclerosis. Among other things, stenosis of the upper cervical spine can cause irritation, inflammation, ischemia and edema of the brain and spinal cord. Chronic irritation, inflammation, ischemia and edema can in turn lead to neurodegenerative conditions such as sclerosis.

        What is the cause of the stenosis in the upper cervical spine. Do you have a naturally stenotic spinal canal or do you have a malformation?

      • Claus says:

        I can only see in my journal that they conclude there is spondylosis present – and they cannot rule out that there is also some stenosis. But that wasn’t entirely clear on the MRI (I would probably need an upright MRI to determine this for sure). So I do not know if there is a naturally stenotic spinal canal or if it is a malformation.
        I fully understand that two lesions in the spinal cord and WBC count of 47 (and the presence of oligoclonal bands) is highly suggestive of MS (the neuro now says there is a 20% risk that it is MS – but it is more likely an idiopathic occurrence of partiel transverse myelitis. However, as you say, chronic irritation (and inflammation) can lead to neurodegenerative conditions. Of who MS is one. But isn’t that the same as saying that if I can “fix” the chronic irritation and inflammation then we can reverse the neurodegenerative condition? I believe MS is a clinical diagnosis – if you fit in the box you can get the dx. But the cause of the condition is still up for discussion.
        I am asking all these questions as I am up for a second opinion with another hospital in Denmark shortly. I want to be prepared and ask them the right questions (including if they can give me an upright MRI…unfortunately there is only one such MR scanner in Denmark and it is in another hospital). I am currently receiving some chiropractic treatment – but considering giving that up for now as my symptoms seem to resurface and I feel very fragile in the neck.
        My personal thought: given that the chiropractic treatments are making my symptoms flare up – and the treatments have been focusing on the neck – I feel the neck is what is causing the problem. So because of that I am putting the treatments on hold and I have just today tried craniosakral therapy for the first time….

      • Some cases of transverse myelitis can be due to vascular causes resulting is chronic ischemia or edema of the cord due to degenerative changes in the spine. Stenosis of the upper cervical spine can decrease arterial and venous circulation resulting in chronic ischemia and edema of the upper cord.

        Divirsified chiropractic adjustments of the cervical spine are contraindicated in your case. Other methods, however, such as specific upper cervical, cervical flexion-distraction, arthrostim and craniosacral-type therapies are all acceptable. I use specific craniosacral-type therapy in cases like yours.

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