Chiari malformation is a condition that causes brain tissue to extend out and settle into the spinal canal. It protrudes out where the skull and neck meet. It occurs because part of the skull is too small or shaped in a unique way that allows part of the brain to settle into the foramen magnum. The foramen magnum is a large opening at the bottom of the skull. The brain’s nerves go through into the spinal canal and join the spinal cord. However, only the nerves should be present. The brain should not be able to push/press/leak through. When it does this is Chiari malformation.
Causes
Chiari malformation can be caused by structural problem/s with the:
Brain
Skull
Spinal canal
Structural conditions/issues can be present at birth, which are congenital defects. This is also called primary Chiari malformation and is not caused by any other condition. Secondary Chiari malformations are caused by something else, most often through surgery. This is extremely rare, but it is possible to develop after having surgery to remove a tumor in the skull or neck region. A surgeon could have removed too much bone while removing the tumor. This allowed the brain to settle into the open space.
Types
There are 4 types and are categorized by how much brain tissue protrudes into the spinal canal.
Type I
This is the adult version and is also the most common.
It is usually first noticed and discovered from an examination for something else. Most individuals don’t realize that they have Chiari malformation unless the symptoms are severe. With Type I a part of the brain, specifically the cerebellar tonsils settle into the foramen magnum.
Type II
Type II is also known as Arnold-Chiari malformation. This is the pediatric version. Symptoms are more severe with Type II because more brain tissue comes through. With this type, the cerebellar tonsils and some of the brainstem protrude. With Type II myelomeningocele, which is a form of spina bifida is a concern. What happens is the vertebrae and spinal canal do not close correctly before birth, so the spinal cord has no protection.
Type III
This type also affects children and is more severe than types 1 or 2. Here a significant portion of the brain, including the cerebellum and the brainstem protrude all the way through the foramen into the spinal canal.
The symptoms vary based on the type and severity. The most common symptom is a headache. Individuals with a Chiari malformation usually have headaches in the occipital region of the brain. This is the back of the head, right where the skull joins the cervical spine/neck. The headaches can be aggravated being in certain positions and actions, tilting the head back, and coughing. Typical symptoms include:
However, Chiari malformation can interrupt the flow of cerebrospinal fluid. Cerebrospinal fluid is necessary to protect the brain and spinal cord. If the normal flow is disrupted it becomes more difficult for the brain and spinal cord to send/receive nerve messages. The pressure built up can also cause nerve issues/problems. For some individuals, symptoms can come and go. This depends on how much cerebrospinal fluid has built up. Individuals with Type I sometimes don’t have any symptoms. It all depends on the severity.
Diagnosis
Diagnosis is done with a magnetic resonance imaging test or MRI. The MRI will show the various parts of the brain, skull, spinal cord, and spinal canal. They will be able to see abnormalities that could point to Chiari malformation.
Treatment
The recommended treatment depends on the severity. If pain is presenting a doctor could recommend pain medications to help manage the pain. Non-steroidal anti-inflammatory meds could also be recommended to reduce inflammation. Analgesics or pain killers can be recommended. Often both non-steroidal anti-inflammatories and analgesics are available in over-the-counter and prescription. The doctor will figure out the best medication treatment plan.
Surgery can be used to relieve symptoms and is the only way to relieve the pressure on the spinal cord and nerves. The goal is to stop the malformation from worsening. Surgeons use a posterior fossa decompression procedure. The surgeon removes part of the skull to make more room for the brain to sit in. This takes the pressure off the brain and spinal cord, and should reduce the neurological symptoms and problems. The surgeon may increase the size of the dura or the sac around the brain.
Laminectomies at C1 and C2, which are the first and second levels of the neck and are utilized to make more room for the brain. The surgeon will place a patch that is made from animal or synthetic tissue that will grow into the dura. The patch makes the dura bigger, which allows more room for the brain. Not all surgeries involve the dural patch.
Neck Pain Chiropractic Care
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The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
A bone graft is defined as using bone-in spine fusion surgery. Spinal fusion’s purpose is to link or weld bones together, in this case, the spinal bones. There are a variety of spinal conditions cause instability and pain:
Degenerative disc disease
Scoliosis
Trauma from an auto accident, sports injury, slip, and fall accident
Spine surgeons use a bone graft to:
Stop motion between two or more vertebrae
Stabilize a spinal deformity
Repair fractures of the spine
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Spinal Fusion Stimulates New Bone Growth
A bone graft does not heal or fuse the spine instantly. Rather a bone graft sets up a foundational frame for the individual’s body to generate and grow new bone. A bone graft stimulates new bone production. It is when this new bone begins to grow and solidify, that fusion takes place.
With these types of surgeries, instrumentation like screws, and rods are typically used for the beginning stabilization. But it is the actual healing of the bone that welds the vertebrae together creating long-term stability.
A bone graft can be used for structural purposes for supporting the spine, usually this is done in place of a disc or bone that was removed. Or it can be an onlay, this means that a mass of bone fragments will grow together to stabilize the spine bridging the joint.
There are two generalized bone graft types:
Real bone
Substituted bone graft
Real bone can come from the patient, which is called an auto-graft or from a donor’s bone, called an allograft.
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The Individual’s Bone or Auto-graft
An auto-graft is bone taken or harvested from the individual’s body and transplanted to a specific area, in this case, the spine. An auto-graft is considered the gold standard because it is the individual’s own bone, which contains:
These all help to stimulate the healing of the fusion. There are advantages for an auto-graft, which include a higher probability for fusion success and a lower risk for disease transmission. The only real setback for individuals of an auto-graft is the post-operative pain that usually comes with the procedure when harvesting an individuals’ bone. Bone can be harvested from one of the individual’s:
Iliac crests
Pelvic bones
Ribs
Spine
� Bone graft harvesting creates a new set of risks. These include:
Because of these risks and the possibility that the bone could be poor quality, a surgeon could decide to use another type of bone graft. When this happens a surgeon could go with what is known as a local auto-graft. This is bone harvested from the decompression itself.
These are the parts that are removed to decompress the nerves. They usually consist of bone spurs, lamina, and portions of the spinous process. These same bone pieces can be reused to assist with the fusion of the decompressed areas.
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Donor Bone or Allograft
An allograft is a bone harvested from another person, usually from a tissue bank. Tissue banks harvest bone and other tissues from cadavers for medical purposes. An allograft is prepared by freezing or freeze-drying the bone or tissues. This helps limit the risk of graft rejection. Bone from an allograft does not have living bone cells and is not as effective at fusion stimulation when compared to an autograft. However, it still does work. Tissue banks:
Screen all their donors
Supervise bone recovery
Test donations
Sterilize donations
Store for use
Look for tissue banks that are accredited by the American Association of Tissue Banks. US Food and Drug Administration has strict regulations when it comes to human cell and tissue processing. These include rules about the eligibility of donors. These guidelines/protocols help reduce the risk of tissue contamination and the spread of disease.
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Bone Graft Substitute
These substitutes are man-made or are made from a manipulated version of a natural product. These alternatives are safe and can provide a solid foundation for the individual’s body to grow bone. Substitutes have similar properties of human bone, which include a porous structure and proteins that stimulate healing.
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Demineralized Bone Matrix – DBM
A demineralized bone matrix is an allograft that has gone through a process where the mineral content has been removed. This demineralization helps reveal bone-forming proteins like collagen, and growth factors hidden within the bone that can stimulate healing.
This procedure is often considered a bone graft extender. It is not considered a replacement. This is because its ability to fuse the human spine on its own has not been proven. DBM can be combined with the regular bone for more volume and is available in these forms:
Chip
Granule
Gel
Powder
Putty
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Ceramic-based Extenders
Ceramic-based extenders are mixed in combination with other sources of bone. This is because they consist of calcium matrix for fusion, but there are no cells or proteins to stimulate the healing process. These include:
Ceramic-based extenders do not present a risk for disease transfer but can cause inflammation. They are available in porous and mesh forms.
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Morphogenetic Protein – BMP
Different types of bone morphogenetic proteins or BMP’s are used to stimulate new bone growth. These proteins are found in human bone, however, they are trace amounts. They are then produced in larger amounts through genetic engineering.
This all depends on the type of spine surgery an individual undergoes. Bone morphogenetic protein could be considered an option in promoting new bone growth along with healing fusion.
FDA recognizes and approves spinal decompression and its ability to eliminate herniated discs.
On the verge of back surgery, a mason discovered the non-surgical solution to work-related chronic back pain.
A new male patient who works in construction came to see me as a last resort to lessen his back pain brought on from damaged/herniated discs.
His primary caregiver recommended back surgery, but that would have put him on disability for months.
Fortunately, before saying yes to the surgery, a co-worker recommended chiropractic care.
Bricklayers/masons have the highest rate of back injuries with non-paid sick leave.
Constant bending over, even with a back brace, takes its toll on the spine, which in this case resulted in two herniated discs.
Pain medications helped in the beginning but with constant use, put him in a constant brain fog state, along with the expense, which took its toll on the family budget.
Disc Injury & Back Surgery
The doctor did not discuss spinal decompression therapy
�A non-surgical back treatment that slowly and gently stretches the spine.
This stretching lessens the pressure on the compressed nerve root (herniated disc) and results in less and even complete alleviation.
The patient came twice a week with myself and the team working on him over the course of a month, however, every case is different so treatments vary depending on the condition.
With each treatment, the two herniated discs were slowly reverted back to their natural position. This is able to be achieved with less pressure between the discs.
Towards the end of treatment, the patient’s pain was gone by about 90%.
With two weeks of rest, the patient was able to return to work.
The best part was that there was no surgery, pain medications, disability, and hospital bills.
Spine treatment alternative
Chiropractic/Decompression therapy is way less expensive than medication and surgery. It is:
Non-surgical
Recovery time is faster
Completely drug-free
People suffering every day with herniated/injured discs should consider the chiropractic decompression option. You do not have to learn to live with chronic back pain.
If you suffer from:
Herniated discs
Bulging discs
Degenerative disc disease
I encourage you to discuss the condition with an experienced chiropractor. There are many proven alternatives to back surgery and pain meds. People need to be aware of these alternatives for chronic back pain. The right-back pain treatment can definitely improve the quality of life.
Herniated Disc El Paso, TX
Sandra Rubio developed two herniated discs and a bulging disc after suffering from an accident at a young age, which caused her intense pain throughout her youth.
When she became a mother, her symptoms became severe.
After visiting doctors without results, Sandra found chiropractor Dr. Alex Jimenez and found relief from her sciatica and migraines.
The herniated disc treatment she received from Dr. Alex Jimenez was non-surgical.
A herniated disc, also known as a slipped disc, is a medical condition in which:
Atear from the outer intervertebral disc allows the soft, central area to bulge out beyond the outer rings.
Disc herniation is usually a result of:
Degeneration (wear/tear)
Trauma (auto accident/sports injury)
Lifting injuries
Straining movement
The tear can release the compounds, which cause inflammation and can cause severe pain even if the nerve root not compressed.
A physical examination is usually the first step in diagnosing a herniated disc. The chiropractor will examine the spine while the patient is standing, and while they’re lying down. Depending on the severity and location of the herniation, they may note a decrease in spine curvature.
Radicular pain will be assessed, when the spine is:
Unmoving
In motion
With pressure applied
Other tests may be administered.
X-rays may also be taken, but an MRI is usually more accurate and shows more detail.
Chiropractic has been very effective in helping patients manage their pain and regain their mobility so they can return to their normal life. Therefore, it should be your first option for treatment before you go down the road with drugs or surgery.
NCBI Resources
It is often referred to as a ruptured disc or slipped disc and occurs when the disc moves or slips out of place. It can also be the result of a disc that has a small tear and is leaking the jelly-like substance that is inside. This can put pressure on the surrounding nerves, causing pain and discomfort.
Spinal decompression therapy involves the stretching of the spine, using a traction table or similar device, with the objective of relieving back pain and/or leg pain.
What is spinal decompression therapy?
This process is known as nonsurgical, spinal decompression therapy (as opposed to surgical spinal decompression like laminectomy and microdiscectomy). This article offers an overview of nonsurgical spinal decompression therapy and its role in treatment of lower back pain and neck pain.
Theory of Spinal Decompression Therapy
Spinal decompression devices use the exact fundamental principle of spinal traction that’s been provided by chiropractors, osteopaths, and other appropriately trained health professionals for many decades. Both traction and decompression therapies are applied together with the aims of relieving pain and promoting the best healing environment for bulging, degenerating, or herniated discs.
Spinal decompression is a type of traction treatment applied to the spine in an attempt to result in several theoretical benefits such as to create a negative intradiscal pressure to promote retraction or repositioning of the herniated or bulging disc material and to produce a reduce pressure in the disc that will cause an influx of recovery nutrients and other substances into the disk.
Clinical Evidence
While the fundamental concept of spinal decompression is broadly accepted as legitimate, there’s a shortage of evidence supporting decompression therapy as being efficacious. There are a number of dangers.
Though some studies that don’t include control groups conclude that decompression treatment is effective, the few that do normally conclude that mechanized spinal decompression is not any greater than sham decompression. Thus, there’s insufficient evidence that spinal decompression therapy is as effective, or even more effective, compared to less expensive manual approaches in treating back pain or injured herniated discs.
An overview of medical literature so far suggests that most clinical trials assessing the effectiveness of spinal decompression therapy or traction were lacking in a couple of regions, such as inadequate numbers of topics to create a statistically valid conclusion, lack of blinding (the individual or provider knows the therapy given), no regard to a placebo group (known as a sham controlled study), or absence of comparison to a treatment substitute. At the time of this report, few clinical studies of spinal decompression therapy have been published in peer reviewed journals.
How Spinal Decompression Works
In nonsurgical spinal decompression therapy, the spine is relaxed and stretched intermittently in a controlled way. The concept is that this process creates a negative intradiscal pressure (pressure inside the disc itself), which is thought to have two possible benefits: pull the herniated or bulging disc material back into the disk; and promote the passage of healing nutrients, into the disc and fosters a better recovery environment.
Spinal Decompression Session
During spinal decompression treatment for the lower spine (lumbar spine), patients stay clothed and lie on a motorized table, the lower half of that which can move. First, a�harness is placed round the hips and can be connected to the lower table close to the toes. The top region of the table then remains in a fixed position while the lower part, where the individual is harnessed, slides back and forth to offer the traction and relaxation.
One difference between different decompression therapies is the patient’s place on the table:
Some devices place the patient in the prone position on the desk, lying down face (e.g. VAX-D)
Some devices have the patient lying supine, face up (e.g. DRX9000)
The patient shouldn’t feel pain during or after the decompression therapy although they should feel stretch in the spine.
Treatment Collection and Costs
While spinal decompression therapy could be advocated as a potential treatment for a number of lower back pain conditions, just like all lower back pain remedies, it’s the patient’s decision whether or not to have the therapy. Although the risk is reduced, the benefit of these treatments isn’t established.
Decompression therapy generally consists of a series of 15 to 30 treatments, lasting 30 to 45 minutes per day, within a four to four six-week period. Sessions are conducted at the practitioner’s office. The price of each session generally ranges from $30 to $200, meaning that a recommended series of remedies will generally cost from $450 to $6,000. Although insurers may cover grip, decompression therapy isn’t usually allowed although they are almost the same.
Sessions may include additional treatment modalities, such as electric stimulation, ultrasound, and cold and/or heat treatment applied during or after the process. Recommendations may also incorporate drinking up to some half-gallon of water per day, remainder, utilizing nutritional supplements, or performing exercises at home to boost strength and mobility. Research and find chiropractors in your area that could help relieve your back and neck discomfort.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
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