Subdural CSF Flow: Implications for Chiropractic Care

Review written by: James Demetrious, DC, DABCO

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Just Fascinating…

Remarkably, the pulsatile, dynamic flow of cerebrospinal fluid (CSF) can sometimes be visualized during spinal surgery. In the following image/video that was posted by Dr. Baaj, we can visualize the posterior lumbar dura during microendoscopic surgery.

At times, upon dissecting and decompressing posterior elements through tubular retractors, thinned and attenuated posterior dura is translucent allowing us to visualize the underlying dynamic CSF flow.

Click to watch Lumbar Sub-dural CSF Flow

Some Considerations

Alterations of CSF flow due to disc herniation, degenerative change, synovial cysts, hypertrophy of the ligamentum flavum, etc. may adversely affect CSF flow. Such alterations of CSF flow must play a role in the genesis of patient symptoms and progressive neurologic degenerative changes.

The chiropractic physician is uniquely qualified to improve segmental mobility of the spine. Empirically, I suspect that this restoration and improvement of segmental mobility via chiropractic care may foster improved CSF flow rates that is attributable to the neurologic response and relief reported by patients.

Further Research

In the absence of research based evidence, clinicians must carry on. During those times, we must rely upon known anatomic and physiologic tenets combined with clinical experience. With improvements of advanced imaging protocols like diffusion tensor imaging and fMRI, perhaps we will glean a better understanding of these mechanisms in time.

Application in Practice

Chiropractic approaches and recommendations that alleviate dynamic intrusions within the spinal canal should be considered to improve patient outcomes.

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