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== Spinal pathologies == === Chiari I malformation === {{Main article|page_name=Chiari malformation}}A Chiari malformation (CM) is a structural defect of the base of the skull and the cerebellum, characterized by a downward displacement of one or both cerebellar tonsils through the foramen magnum (the opening at the base of the skull). This can sometimes lead to non-communicating [[hydrocephalus]] as a result of obstruction of [[cerebrospinal fluid]] (CSF) outflow. While many clinical criteria consider Chiari malformation to be a differential diagnosis, a Swedish study of 234 ME/CFS patients meeting the [[Canadian Consensus Criteria]] found that a substantial proportion of patients had signs on their brain MRIs suggestive of intracranial hypertension: 55% had increased diameter of the optic nerve sheath. In addition 80% had cerebellar tonsillar descent that could potentially cause disruptions to spinal fluid flow, and thus increased intracranial pressure. 13.2% had tonsillar herniations severe enough to be considered a Chiari Malformation.<ref>{{Cite journal|url= https://www.frontiersin.org/articles/10.3389/fneur.2020.00828/full|access-date=2020-12-17 | title = Signs of Intracranial Hypertension, Hypermobility, and Craniocervical Obstructions in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | date = Aug 28, 2020 | last = Bertilson | first=Bragee | author-link = | last2 = Fahlgren | first2 = Michos | first3=Brandon | last3 = Drum | first4 = Robert | last4 = Szulkin | first5 = Bo C | last5 = Bertilson | authorlink2 = |archive-url=|doi=10.3389/fneur.2020.00828|journal=Front. Neurol.|volume =11 | page = 828|archive-date=|url-status=}}</ref> === Craniocervical instability === {{Main article|page_name=Craniocervical instability}}Craniocervical instability (CCI) is a pathological condition of increased mobility at the craniocervical junction, the area where the skull meets the spine. In CCI the ligamentous connections of the craniocervical junction can be stretched, weakened or ruptured.<ref name=Henderson2017 /><ref name="Choi2013">{{Cite journal | last =Choi | first = Sung Ho | last2 = Lee | first2 = Sang Gu | last3 = Park | first3 = Chan Woo | last4 = Kim | first4 = Woo Kyung | last5 = Yoo | first5 = Chan Jong | last6 = Son | first6 = Seong | date = Apr 2013 | title = Surgical Outcomes and Complications after Occipito-Cervical Fusion Using the Screw-Rod System in Craniocervical Instability|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698232/|journal=Journal of Korean Neurosurgical Society|volume=53|issue=4|pages=223–227|doi=10.3340/jkns.2013.53.4.223|issn=2005-3711|pmc=3698232|pmid=23826478}}</ref> CCI usually develops as a result of physical trauma such as a car accident, an inflammatory disease such as rheumatoid arthritis or a congenital disorder such as Down's syndrome.<ref name="Ashafai2019">{{Cite journal | last = Ashafai | first = Nabeel S. | last2 = Visocchi | first2 = Massimiliano | last3 = Wąsik | first3 = Norbert | date = 2019 | title = Occipitocervical Fusion: An Updated Review | url =https://www.ncbi.nlm.nih.gov/pubmed/30610329|journal=Acta Neurochirurgica. Supplement|volume=125|pages=247–252|doi=10.1007/978-3-319-62515-7_35|issn=0065-1419|pmid=30610329}}</ref> More recently, physicians have reported an increased prevalence of CCI in patients with hereditary disorders of connective tissue such as Ehlers Danlos Syndromes (EDS).<ref name="Henderson2016">{{Cite journal | last =Henderson | first=Fraser C. | date = 2016 | title=Cranio-cervical Instability in Patients with Hypermobility Connective Disorders|url=https://www.omicsonline.org/open-access/craniocervical-instability-in-patients-with-hypermobility-connective-disorders-2165-7939-1000299.php?aid=71754|journal=Journal of Spine|language=en|volume=05|issue=02|doi=10.4172/2165-7939.1000299|issn=2165-7939}}</ref> There have also been anecdotal reports of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) who were later diagnosed with CCI,<ref name=":0">{{Cite web|url=https://forums.phoenixrising.me/index.php?threads/have-you-ruled-out-chiari-as-a-cause-of-your-cfs.56908/ | title = Have you ruled out Chiari as a cause of your CFS | last = | first = | date = | website = Phoenix Rising|archive-url=|archive-date=|url-status=|access-date=}}</ref><ref name=":1">{{Cite web|url=https://medium.com/@jenbrea/cci-tethered-cord-series-e1e098b5edf | title = CCI + Tethered cord series | last =Brea | first = Jennifer | date = 2019-06-06 | website = Medium|language=en|access-date=2019-06-06}}</ref><ref name=":4">{{Cite web|url=https://www.mechanicalbasis.org/interviews.html | title = Craniocervical instability, Atlantoaxial Instability, Myalgic Encephalomyelitis, ME, CFS|website=MEchanical Basis|language=en|access-date=2019-06-06}}</ref> although no scientific publication on this subject exists. It frequently co-occurs with [[atlantoaxial instability]] (AAI).{{Citation needed|reason= | date = 10 December 2019}} === Atlantoaxial instability === {{Main article|page_name=Atlantoaxial instability}}Atlantoaxial instability (AAI) is characterized by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bone or ligament abnormality. It can be caused by congenital conditions, inflammatory conditions like [[rheumatoid arthritis]], as a result of physical trauma, or infection.<ref name="AI-medscape">{{Cite journal | date = 2019-11-10 | title = Atlantoaxial Instability: Background, Pathophysiology, Etiology|url=https://emedicine.medscape.com/article/1265682-overview|website=Medscape}}</ref> It has been associated with Down syndrome, Morquio syndrome,<ref name="Li2010">{{Cite journal | last =Li | first = Ming-Feng | last2 = Chiu | first2 = Pao-Chin | last3 = Weng | first3 = Mei-Jui | last4 = Lai | first4 = Ping-Hong | date = 2010-12-13 | title = Atlantoaxial Instability and Cervical Cord Compression in Morquio Syndrome|url=https://jamanetwork.com/journals/jamaneurology/fullarticle/801729|journal=Archives of Neurology|language=en|volume=67|issue=12|pages=1530–1530|doi=10.1001/archneurol.2010.308|issn=0003-9942}}</ref> [[Marfan syndrome]],<ref name="Herza2002">{{Cite journal | last =Herzka | first = Andrea | last2 = Sponseller | first2=Paul D. | last3 = Pyeritz | first3 = Reed E. | date = 2000-02-15 | title = Atlantoaxial Rotatory Subluxation in Patients With Marfan Syndrome: A Report of Three Cases|url=https://journals.lww.com/spinejournal/Abstract/2000/02150/Atlantoaxial_Rotatory_Subluxation_in_Patients_With.22.aspx|journal=Spine|language=en-US|volume=25|issue=4|pages=524|issn=0362-2436}}</ref><ref name="MacKenzie2003">{{Cite journal | last =MacKenzie | first = James MacKintosh | last2 = Rankin | first2 = Rosslyn | date = Dec 2003 | title = Sudden Death Due to Atlantoaxial Subluxation in Marfan Syndrome|url=https://journals.lww.com/amjforensicmedicine/Abstract/2003/12000/Sudden_Death_Due_to_Atlantoaxial_Subluxation_in.12.aspx|journal=The American Journal of Forensic Medicine and Pathology|language=en-US|volume=24|issue=4|pages=369|doi=10.1097/01.paf.0000097853.26115.bb|issn=0195-7910|pmc=|pmid=|quote=|access-date=|via=}}</ref> and [[Ehlers-Danlos syndrome]].<ref name="Halko1995">{{Cite journal | last =Halko | first = G.J. | authorlink = | last2 = Cobb | first2 = R.|author-link2 = | last3 = Abeles | first3=M. | author-link3 = | date = Nov 1995 | title = Patients with type IV Ehlers-Danlos syndrome may be predisposed to atlantoaxial subluxation|url=https://pubmed.ncbi.nlm.nih.gov/8596160/|journal=The Journal of Rheumatology|volume=22|issue=11|pages=2152–2155|doi=|issn=0315-162X|pmc=|pmid=8596160|access-date=|quote=|via=}}</ref><ref name="Henderson2017" /><ref name="Castori2015">{{Cite journal | last =Castori | first = Marco | last2 = Morlino | first2 = Silvia | last3 = Ghibellini | first3 = Giulia | last4 = Celletti | first4 = Claudia | last5 = Camerota | first5 = Filippo | last6 = Grammatico | first6 = Paola | date = 2015 | title=Connective tissue, Ehlers–Danlos syndrome(s), and head and cervical pain|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/ajmg.c.31426|journal=American Journal of Medical Genetics Part C: Seminars in Medical Genetics|language=en|volume=169|issue=1 | pages = 84–96|doi=10.1002/ajmg.c.31426|issn=1552-4876}}</ref><ref name="Lane2006">{{Cite journal | last =Lane | first = D. | date = 2006-08-01 | title = Anaesthetic Implications of Vascular Type Ehlers-Danlos Syndrome|url=https://doi.org/10.1177/0310057X0603400412|journal=Anaesthesia and Intensive Care|language=en|volume=34|issue=4|pages=501–505|doi=10.1177/0310057X0603400412|issn=0310-057X}}</ref><ref name="Dordoni2016">{{Cite journal | last =Dordoni | first = Chiara | last2 = Ciaccio | first2 = Claudia | last3 = Venturini | first3 = Marina | last4 = Calzavara‐Pinton | first4=Piergiacomo | last5 = Ritelli | first5 = Marco | last6 = Colombi | first6 = Marina | date = 2016 | title=Further delineation of FKBP14-related Ehlers–Danlos syndrome: A patient with early vascular complications and non-progressive kyphoscoliosis, and literature review | url =https://www.onlinelibrary.wiley.com/doi/abs/10.1002/ajmg.a.37728|journal=American Journal of Medical Genetics Part A|language=en|volume=170|issue=8|pages=2031–2038|doi=10.1002/ajmg.a.37728|issn=1552-4833}}</ref><ref name="Giunta2018">{{Cite journal | last =Giunta | first = Cecilia | last2 = Baumann | first2 = Matthias | last3 = Fauth | first3 = Christine | last4 = Lindert | first4=Uschi | last5 = Abdalla | first5 = Ebtesam M. | last6 = Brady | first6 = Angela F. | last7 = Collins | first7 = James | last8 = Dastgir | first8 = Jahannaz | last9 = Donkervoort | first9 = Sandra | date = Jan 2018 | title = A cohort of 17 patients with kyphoscoliotic Ehlers–Danlos syndrome caused by biallelic mutations in FKBP14 : expansion of the clinical and mutational spectrum and description of the natural history|url=https://www.nature.com/articles/gim201770|journal=Genetics in Medicine|language=en|volume=20|issue=1|pages=42–54|doi=10.1038/gim.2017.70|issn=1530-0366|pmc=|pmid=|quote=|access-date=|via=}}</ref><ref name="Bhahirati1990">{{Cite journal | last =Bhatia | first = S.J. | authorlink = | last2 = Rathod | first2 = N.M.|author-link2 = | last3 = Vasudevan | first3= D. | authorlink3 = | last4 = Abraham | first4 = P. | authorlink4 = | date = May 1990 | title = Sporadic Ehlers-Danlos syndrome with neurologic, cardiac and dental involvement|url=https://pubmed.ncbi.nlm.nih.gov/2387821/|journal=The Journal of the Association of Physicians of India|volume=38|issue=5|pages=361–363|doi=|issn=0004-5772|pmc=|pmid=2387821|access-date=|quote=|via=}}</ref><ref name="Galan1995">{{Cite journal | last =Galan | first=Enrique | last2 = Kousseff | first2 = Boris G. | date = 1995-04-01 | title = Peripheral neuropathy in Ehlers-Danlos syndrome|url=http://www.sciencedirect.com/science/article/pii/088789949500003X|journal=Pediatric Neurology|volume=12|issue=3|pages=242–245|doi=10.1016/0887-8994(95)00003-X|issn=0887-8994}}</ref><ref name="Wills2006">{{Cite journal | last =Wills | first=Brian P. D. | last2 = Dormans | first2=John P. | date = Apr 2006 | title = Nontraumatic Upper Cervical Spine Instability in Children|url=https://journals.lww.com/jaaos/Citation/2006/04000/Nontraumatic_Upper_Cervical_Spine_Instability_in.5.aspx|journal=JAAOS - Journal of the American Academy of Orthopaedic Surgeons|language=en-US|volume=14|issue=4|pages=233|issn=1067-151X| doi = | pmc = | pmid = | quote = |access-date=|via=}}</ref> === Cervical stenosis === {{Main|page_name=Cervical spinal stenosis}} A 2018 case study published by [[Peter Rowe]] found marked post-operative improvement of symptoms in three patients with severe [[myalgic encephalomyelitis]], [[orthostatic intolerance]] and cervical spinal stenosis.<ref name="Rowe2018" /> === Tethered cord syndrome === {{Main article|page_name=Tethered cord syndrome}}Tethered cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. It can be congenital or acquired and appear in childhood or adulthood. It is considered progressive.<ref>{{Cite web|url=https://www.ninds.nih.gov/Disorders/All-Disorders/Tethered-Spinal-Cord-Syndrome-Information-Page | title = Tethered Spinal Cord Syndrome Information Page {{!}} National Institute of Neurological Disorders and Stroke|website=[[National Institute of Neurological Disorders and Stroke]]|access-date=2019-07-26}}</ref> It causes spinal cord hypoperfusion, electrophysical changes and metabolic changes, including impaired glucose metabolism.<ref name="Colohan2007">{{Cite journal | last =Colohan | first=Austin R. T. | last2 = Zouros | first2=Alexander | last3=Siddiqi | first3 = Javed | last4 = Yamada | first4 = Shoko M. | last5 = Yamada | first5 = Brian S. | last6 = Pezeshkpour | first6 = Gholam | last7 = Won | first7 = Daniel J. | last8 = Yamada | first8 = Shokei | date = 2007-08-01 | title = Pathophysiology of tethered cord syndrome and similar complex disorders|url=https://thejns.org/view/journals/neurosurg-focus/23/2/foc-07_08_e6.xml|journal=Neurosurgical Focus|language=en-US|volume=23|issue=2|pages=1–10|doi=10.3171/FOC-07/08/E6|issn=1092-0684}}</ref><ref name=Colohan2009>{{Cite journal | last =Colohan | first=Austin R. T. | last2 = Yamada | first2 = Shokei | date = 2009-01-01 | title = Tethered Cord Syndrome|url=https://thejns.org/view/journals/j-neurosurg-spine/10/1/article-p79.xml|journal=Journal of Neurosurgery: Spine|language=en-US|volume=10|issue=1|pages=79–80|doi=10.3171/2008.10.SPI15714L}}</ref><ref name=Sullivan2010>{{Cite journal | last =Sullivan | first = Stephen | last2 = Park | first2 = Paul | last3 = Stetler | first3=William R. | date = 2010-07-01 | title = Pathophysiology of adult tethered cord syndrome: review of the literature|url=https://thejns.org/view/journals/neurosurg-focus/29/1/2010.3.focus1080.xml|journal=Neurosurgical Focus|language=en-US|volume=29|issue=1| pages = E2|doi=10.3171/2010.3.FOCUS1080|issn=1092-0684}}</ref> As with [[craniocervical instability]], There have also been anecdotal reports of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) who were later diagnosed with tethered cord, although no scientific publication on this subject exists.<ref name=":0" /><ref name=":1" /><ref name=":4" /> === Tarlov cysts === {{Main article|page_name=Tarlov cyst}}Perineural cysts or Tarlov cysts (TCs) are nerve root dilations resulting from pathologically increased cerebrospinal fluid pressure. A study of 197 ME/CFS patients found that the prevalence of Tarlov cysts was three times higher in ME/CFS patients than the general population, at 39%.<ref name=Hulens2020>{{Cite journal | last =Hulens | first = Mieke | last2 = Bruyninckx | first2=Frans | last3 = Dankaerts | first3=Wim | last4 = Rasschaert | first4=Ricky | last5 = De Mulder | first5 = Peter | last6 = Stalmans | first6 = Ingeborg | last7 = Vansant | first7 = Greet | last8 = Bervoets | first8 = Chris | date = 2020-12-01 | title = High Prevalence of Perineural Cysts in Patients with Fibromyalgia and Chronic Fatigue Syndrome|url=https://academic.oup.com/painmedicine/advance-article/doi/10.1093/pm/pnaa410/6015822|journal=Pain Medicine|language=en|pages=pnaa410|doi=10.1093/pm/pnaa410|issn=1526-2375}}</ref>
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