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Arnold-Chiari I Malformation

The yellow arrow indicates the herniated tonsil. This part should stay above the horizontal yellow line.

The yellow arrow indicates the herniated tonsil. This part should stay above the horizontal yellow line.

Chiari I Malformation (CMI) is a condition in which the cerebellar tonsils sink down from the cerebellum into the foramen magnum. This may affect various functions. First, this area of the body (the brainstem) is very sensitive and crowded. The sagging of the tonsils can compress these sensitive tissues or otherwise take up space impeding their function. Additionally there is a nutrient rich fluid, Cerebral Spinal Fluid (CSF), which flows out of the ventricles and baths the brain and spinal cord. As there is not blood circulating the inner brain and spinal cord, CSF provides nutrients to this area. As these tonsils start to droop or sag, they stop up the fluid like a cork in a wine bottle. This decrease in CSF movement to the rest of the spinal canal may also keep the spinal cord from receiving sufficient nutrients giving rise to a variety of symptoms.

From the abstract of one article, “The diagnosis and management of Chiari I malformations (CMI) remains controversial, particularly since it is often an incidental finding on cervical MR scans performed for neck pain and/or headaches.”

Because the cerebellum is in the cranial vault, traditional treatment options have been few and extremely invasive. The goal of surgical interventions, as the article states, is to “restore normal CSF flow dynamics at the craniocervical junction, and hence, decrease the signs and symptoms attributed to CMI”. The goal is spot-on, but the methods are risky at best.

One treatment commonly employed is a craniectomy. This is a removal of part of the patients skull in an attempt to reroute the fluid. Another procedure is to remove the posterior portion of the first two vertebra allowing the CSF to detour around the herniated tonsils.

chiari malformation

“Posterior fossa decompression surgery is performed on adults with [Chiari I Malformation] to create more space for the cerebellum and to relieve pressure on the spinal column. Surgery involves making an incision at the back of the head and removing a small portion of the bottom of the skull and sometimes part of the spinal column to correct the irregular bony structure. The neurosurgeon may use a procedure called electrocautery to shrink the cerebellar tonsils. This surgical technique involves destroying tissue with high-frequency electrical currents.”

Wow! I thought cave men were barbaric when they were said to have bored holes in their heads to relieve pressure. This goes one step further by literally frying or cauterizing tissue. We are talking about a persons brain! Unfortunately, essential anatomy is overlooked in favor of attempting to bypass the problem, and in the process, creating new ones. The skull is protecting the brain. How many times have you hit the back of your head? Simple put, you need your skull.

There is an alternative way to manage this “irregular bony structure”. A traditional chiropractic manipulation of the neck is not advised. A Chiari Malformation is contraindicated for general chiropractic and could lead to serious injury. However, a specific chiropractor that has training beyond normal curriculum in the upper cervical spine may be able to help. This chiropractor will complete a thorough exam and take appropriate imaging of the neck, in addition to the imaging that may have already been taken. If there is any twisting or cracking of the neck, you know you’re not in the right place.

Complex anatomy of the upper cervical spine. (Image by Danny Quirk)

Complex anatomy of the upper cervical spine. (Image by Danny Quirk)

An upper cervical chiropractor understands the relationship of the various structures surrounding the upper cervical spine. This doctor can accurately analyze and correct the misalignment of the first vertebra with a light maneuver. Some upper cervical chiropractors use an instrument to align this vertebra. The additional imaging is to see exactly how the vertebrae are misaligned. This is essential to know before any correction is to be performed.

As the structures of the upper cervical spine are put into proper alignment, the mechanical plug of the cerebellar tonsils may release and relieve the area of pressure. The body will then begin to heal and respond positively so long as the correct alignment is maintained.

Additional Resources

Smith, JL. Effects of upper cervical subluxation concomitant with a mild Arnold-Chiari malformation: a case study.  Chiropractic Research Journal, 1997;4(2):77-81

Baisden J. Controversies in Chiari I malformations. Surgical Neurology International 2012; 3:232-7.

York, Craig. Video: Chiari 0 Case Study. Orthospinology.org, June 2011

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