Before we get flooded with cries of "see, see, definitive proof at last!!", I just want to highlight that, at least in my view, this is just the very start of the process that needs to be gone through to establish the prevalence of 'neck/spine issues' in our patient population, and then to establish the value, or otherwise, of surgery.
But what's the point in being right if you don't get say "you see, I told you so"! It takes all the fun away if you cannot say that!
Most strikingly it looks as if most PWME have not one but four causes for their illness.
One of the ideas some of us had when first contemplating craniocervical instability, Chiari and spinal stenosis in ME/CFS was that it could be the blockage of cerebrospinal fluid (CSF) flow which was causing issues.
CSF flow blockage often leads to intracranial hypertension (raised CSF pressure), so the fact that this Swedish study found potential CSF blockages (in the form of cerebellar tonsil decent and spinal canal obstructions) as well as intracranial hypertension suggests that CFS flow stagnation might be common in ME/CFS.
My thoughts were that since much of the brain's immune system resides in the cerebrospinal fluid, if the CSF flow is stagnated due to mechanical obstruction, then presumably the immune system is going to have a hard time coping with any viral infection that enters the brain.
Thus having any form of CSF obstruction — whether CCI, Chiari, cervical spinal stenosis, etc — may be like a time bomb in the body: it may not cause many symptoms on its own, but if you are unfortunate enough to catch a virus that manages to breach into the brain, then the compromised CSF immune system may have a hard time clearing this virus from the brain.
Perhaps the infected brain may then have to fall back on its resident microglia to fight the infection — and these microglia once activated may create some of the symptoms and problems of ME/CFS.
Anyway, that's one hypothesis of how viral infection plus a CSF obstruction may lead to ME/CFS. It ties together the viral theories of ME/CFS with these newly-discovered structural abnormalities in ME/CFS.
Some info about the CSF-based immune system in
this article:
Until recently, the central nervous system (CNS) was thought to be cordoned off from the peripheral immune system, reliant only on its resident immune cells called microglia. Peripheral immune-cell breaches anywhere in the CNS were considered signs of disease. But researchers now know that diverse immune cells—possibly by the millions—circulate in the cerebral spinal fluid (CSF) and live in the brain’s outer membranes even in healthy individuals.
