Chiari Malformation and the Upper Cervical Spine
at Southern Spinal Care, PC

Chiari malformation is a structural defect in the base of the skull and/or cerebellum.¹ The cerebellum is a distinct portion of the brain that controls posture, balance, speech, and coordination.² Under normal conditions, the cerebellum and a portion of the brain stem sit above an opening in the skull that the spinal cord passes through; called the foramen magnum.¹ Chiari malformation describes a displacement when part of the cerebellum has moved into the foramen magnum and upper spinal canal.¹ What is being described is essentially a faulty relationship between two opposing tissues at a critical juncture in the human anatomy. The two major players are bone (hardest tissue in the body) and nerve/brain tissue (softest tissue in the body). Basically, the lower part of the brain is not where it should be.

The general region where all of this is taking place can be called the craniocervical junction (CCJ); where the head and the neck meet. The CCJ is made up of the base of the skull, atlas (C1 vertebra), and axis (C2 vertebra) as well as the muscles and connective tissues that join the skull and cervical spine.³ Additional soft tissues involved include the dura mater; the lining of the inside of the spinal canal, and the dentate ligament which anchors the brain and spinal cord to the dura mater and subsequently to the skull and upper spine.³ This critical juncture contains the physical structures responsible for the circulation of blood, neurological signal, and cerebrospinal fluid (CSF) related to normal function and health of the human body. CSF is a colorless liquid that surrounds the brain and spinal cord.⁴ The function of CSF is to cushion the brain and central nervous system as well as to transport nutrients and remove waste products from the brain.⁴ Malformations and misalignments of the CCJ obstruct blood and CSF circulation which leads to neurological degeneration and a wide variety of conditions and symptoms.³ This is the anatomical and physiological principle behind Chiari malformation.

Chiari malformations may be due to abnormal shape or size of the skull, which forces the cerebellum to be pushed down into the spinal canal like a cork in the top of a bottle.¹ Besides for blocking the normal flow of CSF, this causes pressure on the cerebellum and brainstem which could affect the vital functions controlled by these structures.¹

Chiari malformation has several theoretical causes in the realm of allopathy.¹ It is most commonly believed to be caused by structural defects in the brain and spinal cord from fetal development.¹ This is known as primary Chiari malformation. Some sources cite genetic mutations or a maternal diet that lacked certain vitamins or nutrients.¹ It is also observed later in life as a result of traumatic injury, disease, or infection.¹ Under these conditions, the diagnosis would be acquired or secondary Chiari malformation.¹ Primary Chiari malformation is traditionally thought to be more common than secondary Chiari malformation.¹ Interestingly to Chiari sufferers, recent research links a growing number of Chiari-type presentations to structural strain or imbalance from prior trauma.³ Flanagan refers to the trauma-induced injury as a structural “strain” which can be best understood as upper cervical (i.e. occipito-atlanto-axial) mal-rotation or misalignment that can occur early in life and remain latent until symptoms first occur.

There are a variety of symptoms commonly associated with Chiari malformation. Headache is the most common sign of Chiari malformation and is often associated with sudden coughing, sneezing, or straining.¹ Other symptoms might include neck pain, hearing difficulty, balance problems, muscle weakness, numbness, dizziness, difficulty swallowing, difficulty speaking, vomiting, tinnitus, scoliosis, insomnia, depression, and problems with fine motor skills.(¹ It is noted that some will experience symptomatic changes over time and some individuals with Chiari malformation may not show any symptoms.¹ Infants with a Chiari malformation may demonstrate difficulty swallowing, mealtime irritability, excessive drooling, a weak cry, gagging, vomiting, arm weakness, stiff neck, breathing problems, developmental delays, and an inability to gain weight.¹

Some common health conditions have a relationship with Chiari malformation and CSF obstruction. Hydrocephalus is a buildup of CSF in the cranial vault around the brain.¹ Chiari malformation can block the normal flow of fluid and cause pressure that is the hallmark of hydrocephalus symptoms.¹ Spina bifida is the incomplete closing of the spine and certain membranes around the spinal cord.¹ Most children with this defect have no neurological problems; however, children with Type II Chiari malformation usually have a form known as myelomeningocele where the baby’s spinal cord remains exposed causing muscle weakness, paralysis, and scoliosis.¹ Syringomyelia may cause a loss of the ability to feel extremes of hot or cold, especially in the hands with possible severe arm and neck pain.¹ Tethered cord syndrome and spinal curvatures known as scoliosis are two more related conditions.¹

Whereas it was once considered relatively rare (1/1000 births), an increase in the use of diagnostic imaging is revealing Chiari malformation may be much more common than once thought.¹ A relevant consideration in this conversation is a reminder that not all Chiari malformations produce significant symptoms.¹

In the realm of allopathic treatment, it is common for doctors to regularly monitor Chiari malformations not producing considerable symptoms.¹ Mild pain or headaches may be managed using medications that can have varied effects. Surgery is another common treatment option and it is noted that multiple surgeries may be needed.¹ The most common surgery used to treat Chiari malformation is posterior fossa decompression. The surgery involves removing portions of bone from the skull and vertebrae that are in contact with neurological tissue.¹ Surgery may also involve opening the protective covering of the brain and spinal cord known as the dura. Additional measures may be deemed necessary, such as cauterizing (burning away) portions of the cerebellum and grafting extra material into the dura.¹

Hydrocephalus may be treated with a shunt that drains fluid and relieves pressure inside the head.¹ Third ventriculostomy is another hydrocephalus option that improves the flow of CSF out of the brain.¹

Freeman et al. define Chiari malformation as herniation of the cerebellar tonsils through the foramen magnum, also known as cerebellar tonsillar ectopia (CTE).⁵ They were able to review nearly 1,200 cervical MRIs of neck pain patients, half who had been in a recent whiplash accident and half who had not.⁵ Their observations suggest that upright MRI revealed nearly a 25% incidence in Chiari malformation presentation (CTE) in patients with a recent history of whiplash trauma, almost five times the incidence found in non-trauma groups and more than double the incidence in the trauma, recumbent group. This seems to confirm the theory that Chiari malformation must be more common than we think and that it must be even more related to trauma than originally suggested. Also, an upright posture is critical for diagnostic accuracy using imaging such as MRI.

Rosa et al. have just recently released research further clarifying the relationship of CCJ integrity, CSF flow, and Chiari malformation (CTE).⁶ Their report describes the relationship of the upper cervical complex to the rest of the cervical spine and skull. Factors in the cervical spine relating to Chiari, CTE and CSF flow are misalignments or mal-rotations of the C1 and C2 vertebrae.⁶ In addition, reversal of normal spinal curvatures creates a downward pull of the spinal cord and cerebellum into the spinal canal creating the exact same scenario that would be diagnosed as Chiari malformation in any common allopathic setting. In this instance, the Chiari malformation is due entirely to traumatic influences affecting the spine instead of genetic influences in the development of the brain and skull. This is very exciting for many Chiari sufferers because it introduces the potential for reversal of cervical spine trauma and improvement of their health condition.

Though not all damage to the upper cervical spine is recoverable, there is a potential to reverse and stabilize the injury that is causing symptoms in most cases. Flanagan referred to the injury as a type of “strain” affecting the CCJ elements. Contemporary researchers have begun to refer to the “craniocervical junction syndrome”; misalignment and mal-rotation of the C1 and C2 vertebrae causing spinal changes that adversely affect all other related tissues including brain and nerve components. This is groundbreaking because not only does this present hope for Chiari sufferers but for people with many types of neurodegenerative and CSF-related conditions.

As you may have guessed by now, this new understanding of Chiari is closely related to a healthcare discipline within the chiropractic profession known as upper cervical care. Most surprisingly, the principle and practices of spinal correction of the upper cervical spine are not new at all. In fact, they have been around since the early 1930’s. In contrast to common medical attitudes, there are many safe and effective ways to correct the spine without twisting and cracking the neck or spine. While some chiropractors use their hands, others use percussion instruments and special tables with drops. Regardless of the method used, chiropractic is the safest of all heathcare professions. Palmer recorded successful management of patients with neurodegenerative conditions such as Hydrocephalus, Multiple Sclerosis, Epilepsy, etc. in the 1940’s using the earliest form of upper cervical corrective technique.⁷ Contemporary researchers are still producing clinical data demonstrating reliable amelioration of symptoms in patients with CCJ misalignment. Nothing is more important to modern research, care and prevention of neurodegenerative conditions than upper cervical chiropractic techniques.⁸

The take-away message is this: Chiari sufferers have a potential healthcare resource in upper cervical care that may provide a drastic change in their health condition without drugs or surgery. People who have tried drugs and one or more surgeries to no avail still have an option in upper cervical care. Individuals having experienced a traumatic event before their symptoms developed or suddenly became worse can now understand the plausible explanation for this. Upper cervical care is also a viable healthcare option for pediatric cases with Chiari-related troubles. Despite the common belief that Chiari malformation is genetic or developed before birth, there is a high likelihood that a traumatic birth (c-section, vacuum extraction, forceps, abnormal presentation, etc.) could cause an upper cervical injury leading to ectopia of the cerebellar tonsils and subsequent symptoms. Even a so-called normal birth can strain the delicate spinal anatomy of an infant, leading to malfunction and chronic illness.

1. Chiari Malformation Fact Sheet. National Institute of Neurologic Disorders and Stroke. Date last modified: Tue, 2019-08-13 22:02. Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Chiari-Malformation-Fact-Sheet
2. Cerebellum. Healthline. Healthline Medical Network. March 5, 2015. Available at: https://www.healthline.com/human-body-maps/cerebellum#1
3. Flanagan, Michael F. The role of the craniocervical junction in craniospinal hydrodynamics and neurodegenerative conditions. Neurology Research International. Volume 2015, Article ID 794829. Available at: https://dx.doi.org/10.1155/2015/794829
4. National Multiple Sclerosis Society. Cerebrospinal Fluid (CSF) [Internet]. National MS Society; 2019. Available from: https://www.nationalmssociety.org/Symptoms-Diagnosis/Cerebrospinal-Fluid-(CSF)
5. Freeman, Michael et al. “A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash).” Brain injury 24 7-8 (2010): 988-94 .
6. Rosa S, Baird JW, Harshfield D, Chehrenama M. Craniocervical junction syndrome: anatomy of the craniocervical and atlantoaxial junctions and the effect of misalignment on cerebrospinal fluid flow. Available at: https://dx.doi.org/10.5772/intechopen.72890
7. Palmer BJ. Chiropractic clinical controlled research. Vol. XXV. Davenport (IA): Palmer School of Chiropractic;1951. p. 358-476.
8. Flanagan, M. Alzheimer’s, Parkinson’s, and Multiple Sclerosis. Getting to the root causes of neurodegenerative diseases. Available at: https://uprightdoctor.wordpress.com/

The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. The purpose of this website is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Chiari Malformation and the Upper Cervical Spine Little River SC | (843) 399-0182