CCSVI and CCVBP

[DrKoontzDC]

Hello Nigel,

The spinal canal has 3 layers of meninges that surround the spinal cord, the dura mater, arachnoid mater and the pia mater. The arachnoid mater is so named because it resembles spider webs. Arachnoiditis is the inflammation of the arachnoid mater.

There are a couple of ways Arachnoiditis could be associated with Chiari malformations. It can occur as a result of chronic cord compression, infection, injury and even complications from spinal surgery. It would be helpful to know if your friend was diagnosed with Arachnoiditis before or after their spinal surgery in order to try and determine whether or not the Arachnoiditis is a result of the chiari malformation or the spinal surgeries. Though I'm inclined to think it's a complication from the surgeries.

[DrKoontzDC]

Dr. Koontz,
The Planmeca looks like a nice piece of equipment.

As an aside, all of the multiple sclerosis and Parkinson's cases I sent to Dr. Rosa's upright cine MRI studies so far have had Chiari 1 malformations and history of significant trauma. None were congenital.

It sounds very interesting, a definite pattern developing, I'm looking forward to hearing more about it!

[NZer1]

Thanks Dr K I am meeting her tomorrow and will ask, I think there is also the standard risk of looking on the Inter-net involved here, and the surgeon not being a good communicator at a 'right' level with the patient.
The surgeon said at one point when checking on the patient following the last surgery that there was a surprise when doing the surgery and that there was not allot he could do. This is a difficult one to unravel and I will help as I can.
Thank you what you have said is of great value.
Regards Nigel

[uprightdoc]

Arachnoiditis is inflammation of the arachnoid mater of the protective membranes (meninges) that surround the cord and brain. It is can be caused by any type of inflammatory condition. It is usually attributed to viruses and bacteria. The arachnoid mater is typically separated from the dura mater by a lubricant. This allows their interfaces to slide on each other during spinal movements. Scar tissues from inflammation can cause the arachnoid mater and its connections to nerve roots to stick.

I recently had a discussion with a patient on my website regarding tethered cords. It is my opinion that injuries and inflammation of the spine can cause functional or kinematic type tethering of the cord due to scar tissue such as from arachnoiditis. As the science and research continue to develop, upright kinematic MRI will most likely show that tethering of the cord is more common than we currently realize similar to Chiari 1 type malformations (cerebellar tonsillar ectopia).

[NZer1]

How do we identify this as an issue to be treated or if not possible, then managed?

Is Upright MRI a help in this dx, at this rate there may be a plane load going to Australia for imaging!

Seems to me that the injury issue could be bigger than we think for many who have a dx of MS, me included!
Where do we draw a line that shows injury causation of a symptom group?
Thanks Guys,
Nigel

[uprightdoc]

Tethered sections of the cord are difficult to treat. There are tools to consider in manual medicine such as long axis and flexion-distraction tables to stretch and release scar tissue as well as to decrease the inflammation and edema. The problem is very few doctors have the right tables and the ones that do are either inadequately trained or don't follow protocols. Physical rehabilitation exercises, electrical muscle stimulation, ultrasound, infrared heat, ice and anti-inflammatory agents are also considerations as are pain management methods, such as acupuncture and TENS.

[neava]

whats the likely hood of a tethered cord to repair itself once an issue as been removed off the cord?
sorry that might no make sence. compression of the spinal cord is caused a questionable tethered cord, once the compression has been relieved, will the tethered cord repair, or will this always be an issue?
also the compression has caused slowing of spinal fluid, would also allow fluid to flow freely, or has this become a tethered cord issue?

[uprightdoc]

I would give the cord some time to recover and heal from the surgery. CSF should flow more freely now that the cyst has been removed. The problem is that certain types of mechanical issues in the spine can cause cysts to form. It they are not addressed the stress on the cord remains. Physical medicine can help reduce inflammation and break up adhesions and scars.

[coach]

still have some hoarseness but much better. interested in checking out tethered cord possibility since both my daughter and I had pp ON. I was hoping I could get my pcp to order mri of my lower back and coccyx but she didn't want to. mri I've had according to report only goes to S1. Have read that one's conus could be in proper position and the patient could still have tc which was the criterion that the dr that did my lamenectomy was going on. I have read about pts. that had tc and normal position of the conus also about something called tight fillum syndrome. would an mri of the coccyx show if pt had a thickened fillum? if one's cord is attached to coccyx could cerebellum and brain stem be pulled down and cause the chiari-like symptoms I have periodically? Would it be wise to get a consult from a NS that has experience with tc? have cosidered my ms to be somewhat atypical since I had the pp ON followed by 14 asymptomatic years followed by a slow progression then a more rapid progression. never had RR course of MS. JUST TRYING TO CONNECT THE dots. orthopedic dr. said that loss of volume in cervical and thoracic cord could be age-related. I'm thinking that if I do have tc a laminectomy would also releive the pullling down on the cord b/c there is more room. If cord is attached at one end it makes sense to me that a laminectomy would help. My Mother in law had her coccyx removed. Your thoughts would be appreciated.

[uprightdoc]

I am a fan of Dr. Thomas Milhorat of the Chiari Institute in New York. I suspect, as does Dr. Milhorat, that there is a connection between tethered cords and Chiari malformations. Tension in the cord can pull the brainstem downwards. In other cases it can be pulled tight toward the clivus of the base of the skull or against the inner walls of the spinal canal. Among other things, the Chiari Institute has developed an innovative approach for assessing tethered cords. In addition to checking for the position of the conus medullaris of the cord, which should end around T12/L1 area, it also involves taking prone and supine images of the cord and filum terminale. In any case, regardless of the cause, a tight cord gets pulled out of position with the changes in posture and position and can further cause symptoms similar to Lhermittes sign due to neck flexion. The Chiari Institute also developed a simple surgical procedure that is less invasive that disc surgery in which they cut the filum terminale to release the tethered cord. Milhorat also showed that upper cervical ligament laxity due to inherited disorders of connective tissues such as Ehler's Danlos or rheumatoid arthritis for example, could cause cranial settling and functional or kinematic Chiari type malformations that pull the brainstem toward the clivus. Whiplash and trauma can similarly cause ligament laxity, subseqent cranial settling and functional or kinematic Chiari type malformations.

[uprightdoc]

The following was posted on my wordpress blog about the upright MRI study being done by Dr. Rosa...

I recently joined an MS Study with Dr. Raymond Damadian and Dr. Scott Rosa, both in New York. This has been an extremely interesting sight and I would love to share my experience so far. This seems to me to all be related..since I also seem to get some relief just by taking aspirin and laying down. Please give me feedback if you have any.

Dr Raymond Damadian from Fonar Corp (fonar.com) recently published a study re MS. He feels he has identified the cause of MS. (his study can be accessed by going to fonar.com) This is personal to me because I have MS.

Dr Damadian is the original inventor of MRI. I worked as a stock broker for the underwriter which brought his company public in 1981. I was quite impressed with his technology. As a witness to the the ridicule he was subjected to then, I later watched all the large medical companies steal his technology. Eventually, he sued them for patent infringement. GE took it all the way to the Supreme Court…Fonar won. With his winnings, he developed the Upright MRI. Among other attributes, it can perform images in the position of gravity.

The significance of this is to make you aware of his recent study. It was the development of the MRI that made it possible to see the scarring of the myelin coating on the nerves of people with MS which I’m sure you all know. Dr Damadian has a new head and cervical coil which along with software, has allowed him to see blockages in the CSF flow in the cervical area. He has been able to measure CSF flow rates and CSF pressure in the brain. His study describes excessive CSF pressure in the brain as a result of these blockages in the upright position in people with MS which is not present in the recumbent position. (Normal people dd not have this) He has also witnessed leakage of CSF around the ventricles in the brain. It is the leakage of the CSF that he feels is the cause of MS. (CSF is made up of water and proteins, several being antigens. These antigens lead to the creation of antibodies that attack the myelin coating on the nerves.) If the blockages are opened up, the leakage of CSF stops. The brain heals itself.

In addition, he feels there is a benign, non invasive and relatively inexpensive way to open up these blockages

I made the trip last February and the following is a summary of my experience:

I just got back from New York on March 1st. Dr Damadian along with Dr Larry Minkoff (the first human ever to be scanned by an MRI) spent many hours directing the scans on my friend and me…I had about 10 hours myself in the scanner. They both analyzed the results. We both had blockages of CSF flow through the cervical spine area and showed leakage around our ventricles in the brain. Mine showed all four ventricles had leakage. I also found out I had scoliosis in the neck and lumbar spine. It was so cool to watch the most leading research scientists in the world consulting for hours over our images. We then went to be treated by Dr Scott Rosa in Rock Hill, NY. That was just as incredible. Dr Damadian came with us…about 3 hours away and Dr Rosa was just as brilliant as the other two doctors. He did his adjustments on my friend and me using an atlas orthogonal device…and I felt nothing! This was the most non invasive procedure known to man. We then were re scanned by Fonar and my neck was in perfect alignment, opening the CSF flow. (My atlas disk was diagonal and rotated and my C2 was rotated before the procedure. After… everything was perfect.) Now, I am going to keep a journal on how the healing goes. They expect the process to take about a year. We will be going for periodic adjustments here in Denver to a chiropractor under Dr Rosa’s direction, to make sure we stay in alignment. Dr Damadian and the other doctors are pretty sure that Parkinson’s, Alzheimer’s, even ALS are related to this same issue. I’ll let you know how it goes. Linda
I have already seen some results. This is significant since I was at the slow progression stage of MS for nine years. My shoulder and neck were in great discomfort. That was gone as soon as I was adjusted by Dr Rosa. I was having some eyesight issues that had prevented me from driving due to kaleidoscope vision when I turned my head. That has been corrected and I can now drive again. I am getting some feeling back in my fingertips…which had been numb for years. Also, I am starting to have some feeling in my abdomen. I have been numb through my abdomen for many years. The real test is to get my balance and ability to walk back. I am more optimistic than I have been in so many years….and I feel so privileged to get the opportunity to be part of his study.

Sincerely, Linda La Rowe

[NZer1]

WOW, thanks for showing us this Dr,

[uprightdoc]

The following is my reply to Linda...

Thank you for your sharing your story. I have sent multiple sclerosis and Parkinson’s cases to several of Dr. Rosa’s studies. It is my opinion that spondylosis (degeneration), scoliosis and stenosis of the spinal canal play a role in the caue of MS. This is due to the fact that degenerative changes of the vertebrae, cartilage and connective tissues can invade the spinal canal. In addition to degenerative changes, abnormal curvatures such as scoliosis and kyphosis and narrowing of the spinal canal compress the epidural space which contains the vertebral veins. The vertebral veins drain the brain and cord. A decrease in flow through the vertebral veins affects blood and CSF flow in the brain and cord. Chronic decreases in blood and CSF flow in the brain and cord can initiate neurodegenerative processes. Over time, it can cause neurodegenerative conditions such as Alzheimer’s, Parkinson’s, multiple sclerosis and amyotrophic lateral sclerosis (ALS).

[NZer1]

Hi everyone,
Dr. F I am very interested in the reason or cause of the lesions found in the CNS. This article was posted elsewhere and has been pushing my thinking.

http://www.ncbi.nlm.nih.gov/pubmed/19652606

I hear you when you say that CSF flow has an association with MS symptoms or probably more correctly CSF flow symptoms do exist.

What I keep coming up against is that the lesions found in MS have veins travelling through them, and also the talk of the capillary bed being the most likely place for breaches of the BBB.

*I then have a question about CSF's purpose and what its contents are required to do?

If the CSF flow is decreased for many possible reasons and the primary one (CCSVI) causing altered blood volume and/or flows, therefore an inability to pump the CSF system at a 'safe' volume.

The lesions found in the CNS don't mention an association with CSF either by contact or by a flow of CSF as a requirement.

*In the Dr Rosa Studies, if the CSF flow is increased is it because only the CSF restriction is changed?

*Or is it because the Arterial and venous flow is changed and therefore the CSF pump action is restored?

*The flow of CSF when stunts are used must give some indication of flow related changes and/or symptoms. Does the CSF system over supply to cater for problems or is it a system that pumps barely enough to create the needed amount?

*Is there evidence of lesions caused by CSF flow issues?

*I am beginning to think that CSF flow issues are a 'co-incidence' when people have CCSVI and MS as well, rather than CSF flow being the primary factor. It may be that the dx of CSF flow issues is a way to help define what else is happening to blood flows in the Brain?

Food for thought?
Nigel

[Taurus]

Does that mean that all people with degenerative discs or protrusions in Spine will end up having MS? What about those who have perfect spine and yet are Suffering with MS or other Neuro-degenerative diseases. Please comment.