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Book review: The Craniocervical Syndrome and MRI

Book Review By Dan Murphy, DC

The Craniocervical Syndrome and MRI

Edited by Francis W. Smith and Jay S. Dworkin

Karger, 2015


Advances in technology are adding to the scientific understanding of the chiropractic adjustment. One such advancement is the use of upright, weight-bearing MRI imaging of the upper cervical spine and head.

The basic premise is that water images differently than non-water on MRI imaging. Hence, if there is an accumulation of water, it can be observed/documented with MRI. Likewise, if an intervention reduces the accumulation of water, it can similarly be observed/documented. Importantly, these studies have noted that the position of the patient when the MRI is exposed influences the accumulation of such water fluid. Most relevant is the imaging difference between a recumbent MRI vs. an upright weight-bearing MRI.

Over the past decade, a number of studies have proposed that if the atlas vertebra is not perfectly aligned with the occipital foramen magnum, it will result in a “corking” of the flow of cerebrospinal fluid and other vascular components that exist in the foramen magnum. This causes a variety of significant health problems, from demyelinating diseases to dementia to chronic headaches, etc.

Stunning for most of the health care community, and even surprising many chiropractors, there is mounting evidence based upon pre- and post-specific chiropractic adjustment of the upper cervical spine that there is a significant and meaningful improvement of water fluid accumulation when the chiropractic adjustment realigns the atlas vertebra perfectly with the occipital condyles. The results are accompanied with often immediate improvement in a variety of clinical signs and symptoms.

A media case study is the improvement of the headaches and dementia of former Chicago Bears NFL quarterback Jim McMahon. McMahon was diagnosed with images from an upright weight-bearing MRI and adjusted with upper cervical chiropractic. McMahon credits his dramatic improvement to the specific upper cervical chiropractic care.

This book by Smith and Dworkin is the best I have seen to scientifically support these concepts. Each chapter of the book has informative gems for clinical chiropractic. A sample of some of the verbiage includes:

Upright MRI “has made it possible to visualize and quantify the dynamic flow of cerebrospinal fluid (CSF) within the cranial vault and spinal canal.”

“Magnetic resonance imaging (MIR) is conventionally performed in the supine position, in which no information about the effect of gravity on the patient in the upright position is possible.”

In the upright position, “not only the alterations in the biomechanics of the body that can be observed, but also alterations in blood flow, venous drainage and cerebral spinal fluid flow that are now amenable to study under the effects of gravity.”

“This is especially so at the craniocervical junction and in the cervical spine, where the weight of the head on the neck can result in significant alteration in the MRI appearance between supine and upright positions.”

“Misalignments of Occiput-C1, C1-C1 … may contribute to cerebrospinal fluid (CSF obstruction.”

Upright MRI “as a means of evaluating misalignments at the craniocervical junction and the images obtained are used to calculate the appropriate vectors to correct the misalignment. Post-corrective advanced upright MRI images are then used to validate the appropriate realignment of occiput-C1, C1-C2 to establish improvement in proper CSF as well as arteriovenous flow.”

All chiropractors who want to remain current in some of the technology advances that are validating clinical chiropractic and to update their understanding of the physiological benefits of the chiropractic adjustment should read this book.



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