Cervical spine instability and Crohn’s disease

In this article, we will discuss Crohn’s disease and how the severity of symptoms can be caused by pressure on the vagus nerve. In the video below a patient describes her symptoms and Dr. Hauser discusses treatment options and goals and reviews the results with the patient.

Many people with a diagnosis of Crohn’s disease are very familiar with possible causes and treatments. There is also a strong chance that your diagnosis of Crohn’s disease is only one of many health challenges you are facing. Some will have a general diagnosis of inflammatory bowel disease, some will have colitis or ulcerative colitis. Like our patient below, symptoms can also include tachycardia which caused her dizziness, ear fullness, vision problems, and anxiety.  At our center, we see many patients with a myriad of mysterious and simultaneous conditions and symptoms. Typically they also start treatment with us by explaining and showing us the shopping bag full of medications they are taking for each symptom and the very thick printout of all the tests they have performed over the years.

Treatment for people with Crohn’s disease and other bowel disorders would include rotating, alternating, and combining antibiotic prescriptions, corticosteroids, and immunosuppressants. When these treatments do not work, then a structural cause, found in cervical spine instability, may be the culprit.

Ross Hauser, MD, with patient Colonel Cope. The patient is a Colonel in the armed forces. A 21-year veteran.

A summary explanation of this video is found below.

According to the patient, she was still having residual head pressure and a whooshing noise in her ears from a cervical spinal fluid leak twelve years prior. Other symptoms were dizziness to the point of nearly passing out. The symptoms were manageable for a few years. At her first appointment it was determined that her vagus nerve was very compressed. She was started on cervical curve correction and Prolotherapy treatments. The patient describes that after the first treatment she noticed changes in her stomach. Her stomach was growling in a good way and she felt her digestion changing.

By the second Prolotherapy treatment many of her Crohn’s symptoms which included frequent restroom breaks (8 – 10 watery bowel movements a day), cramping, and discomfort were being alleviated. She notes that she was going to the bathroom a lot less and having a more normal bowel experience.

The patient was first diagnosed with acute Crohn’s Disease in 2015. She reports that she was having severe pain and went into an emergency room. She was diagnosed as having an intestinal stricture. It created an abscess and she was hospitalized for six weeks. Her doctors could not figure out what was causing the stricture. She was ultimately sent to surgery where two feet of her intestines were removed. She was ultimately diagnosed with Crohn’s Disease and it was after surgery that her symptoms began.. She reported that she was 35 years old at the time and had never had issues, so this was an odd diagnosis for her. In 2019 the symptoms worsened. Doctors could agree something was wrong but they could not agree on what was wrong. The patient tells of continuing problems with symptoms and that she did not want to take medications. Specifically her doctors prescribed Humira which she declined because she says the military would not allow her to continue to serve while on Humira. Humira is an immunosuppressive drug.

At the time of this video, the patient was in for her fourth visit. Usually on the fourth visit we may re-test and reevaluate the progress the patient is taking

The patient is described as having cervical vagopathy or vagus nerve degeneration. The nerve messages to the colon have been disrupted and traced to the vagus nerve. When the vagus nerve input into the digestive tract is compromised, among other things, food stuff and bacteria can get into the colon or the intestines and cause an inflammatory reaction.

Even in a situation of intestine retraction, cervical spine instability will still cause stretch and compression on the Vagus nerve and the problems of Crohn’s disease will continue.

At the first visit testing revealed C1 / C2 there instability affecting the vagus nerve and jugular vein.

At the four visit evaluation the patients says:

  • Changes in sleep position and computer use has helped.
  • Tachycardia which caused her dizziness upon rising is gone. Sometimes the symptoms reappear when she pushes herself physically.
  • She describes vision issues early on in her diagnoses. At her initial examination with us, pupil dilation was noted. The patient says this was a revelation and made so much sense as for years she would see doctors for vision problems but no one could pinpoint it.
  • She reports that ear fullness has resolved on her left side, on the right side where the C1 “wanders” occasionally has fullness.
  • The patient also reports she feels less anxious.

At 16:00 minutes the patient’s four treatment evaluation and comparison.

  • At 17:30 a styloid is noted
  • At 21:00 a discussion of the Atlas projected 7 mm (a little more than a quarter inch) forward of the occiput. A goal of treatment is to reduce this projection. This would help create more room for the styloid and help the patient avoid surgery. It would also help avoid jugular vein compression.

Below is an image of a different patient being used for illustration. In many people we see, they present with a straight neck or a loss of the cervical spine curve. The goal of our cervical realignment therapy is to bring back the natural curve and restore the cervical neck to proper anatomic position. This would help alleviate many of the problems we see in our patients.

At 22:00 minutes of the video, Dr. Hauser reviews the findings of the patient’s digital motion x-ray

1 minute clip at 22:14

DMX movement X-Ray in the patient is demonstrated

  • At 26:40 of the video, Dr. Hauser explains that the treatments have provided compression relief on the right vagus nerve and this was a structural reason why the patients Crohn’s disease may have had significant symptom relief.
  • At 28:25 the patients results reveal that she has had great improvement in the compression on the jugular vein. The brain can drain better and circulation improved. Brain pressure was greatly improved. Optic nerve sheath diameter, MCA velocities went down. Brain function and reduction of anxiety was noted.
  • Pupil dilating was normalizing.

The immune system and vagus nerve stimulation

The vagus nerve plays a major role in the inflammatory reflex that controls the body’s immune responses and inflammation. This topic is covered in more detail in these articles:

The vagus nerve has anti-inflammatory properties and stimulation of the vagus nerve can help put Crohn’s disease into remission

An October 2020 study in the journal Neurogastroenterology and motility (1) lead by researchers at the University of Grenoble Alpes, in Grenoble, France explains that “The vagus nerve has anti-inflammatory properties,” therefore the researchers investigated vagus nerve stimulation (VNS) as a new anti-inflammatory therapeutic strategy to target Crohn’s disease.

In this study, nine patients with moderate and active Crohn’s disease underwent vagus nerve stimulation (VNS). An electrode wrapped around the left cervical vagus nerve was continuously stimulated over 1 year.

  • After 1 year of VNS, five patients were in clinical remission and six in endoscopic remission (no signs of inflammation).
  • C-reactive protein (CRP (an inflammatory marker)) and fecal calprotectin (a marker looking for inflammation in the gastrointestinal tract) decreased in six and five patients, respectively.
  • Seven patients restored their vagal tone and decreased their digestive pain score.

In this small study we can see that restoring vagal tone in some patients will help put their Crohn’s disease into remission.

The nerves are not communicating correctly

An August 2014 study, also from researchers at the University of Grenoble Alpes, (2) connected autonomic dysfunction (the nerves are not communicating correctly. These symptoms can manifest themselves as problems with blood pressure, digestive problems and cardiac-like episodes) and mood disorders that are frequently described in Crohn’s disease (CD). Autonomic dysfunction could create a situation of hypersensitivity to pain in the body organs such as the stomach and digestive organs). The connection between autonomic dysfunction, anxiety, depressive symptomatology and Crohn’s disease was the vagus nerve.

The gut is a critical regulator for immune and cognitive functions as well

A 2020 paper from Yale University (3)  described the vagus nerve as a critical link between gut signals and the brain regulating. “New findings of the gut-brain axis are shaping the way we live and making important improvement for human health. The gut is not only considered as a system for digestion but a critical regulator for immune and cognitive functions as well. Vagal sensory neurons convey important gut signals to the brain, providing an excellent therapeutic target for treating digestive, immunological, and psychological diseases.”

The hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system are out of balance

An October 2022 paper in the journal Journal of clinical medicine (4) wrote: “The demonstration that the vagal system affects inflammation regulation has endorsed exploratory attempts (research) at therapeutics (new treatments). Neuromodulation (electrical nerve stimulation) suggests using devices to control the nervous system’s electrical activity in order to restore organ function and health . . .In gastroenterology, clinicians have focused on inflammatory bowel disease (IBD). Inflammatory bowel disease is characterized by an imbalance of the autonomic nerve system, vagal dysfunction in ulcerative colitis, and sympathetic dysfunction in Chron’s Disease . . . High serum TNF-α levels (inflammatory marker) and salivary cortisol levels were connected with low vagal tone in Chron’s Disease patients, supporting the idea that the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system are out of balance.”

In December 2022 a paper published in the journal Cells  (5) suggests “Targeting the inflammatory process of irritable bowel disease with artificial stimulation of certain branches of vagus nerve could be achieved through neuroprostheses (electrical stimulation) to restore intestinal homeostasis (ther balance of the gut ecosystem). The main disadvantages of (surgical implant) stimulating the cervical vagus nerve are the highly invasive approach and the likely stimulation of nerve fibers that are not in the cervical trunk of the vagus nerve (the overstimulation of the vagus nerve), which can cause adverse side effects. . . a matter still to be clarified is the effect of vagus nerve stimulation on the intestinal microbiota, either beneficial (stimulated) or harmful (over stimulated vagus nerve), which are the changes induced to the resident microbiota and, consequently, its contribution in triggering other chronic diseases or in modulating the effect of treatment. Inversely, vagus nerve stimulation’s direct and indirect beneficial role should also be (better understood and studied) . . . it is essential to understand the secondary effects of this treatment on gut microbiota and the possibility of a consequent triggering (or facilitation) of the development of IBD-like diseases.”

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

We hope you found this article informative and it helped answer many of the questions you may have surrounding your issues. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

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References

1 Sinniger V, Pellissier S, Fauvelle F, Trocmé C, Hoffmann D, Vercueil L, Cracowski JL, David O, Bonaz B. A 12‐month pilot study outcomes of vagus nerve stimulation in Crohn’s disease. Neurogastroenterology & Motility. 2020 Oct;32(10):e13911. [Google Scholar]
2 Rubio A, Pellissier S, Picot A, Dantzer C, Bonaz B. The link between negative affect, vagal tone, and visceral sensitivity in quiescent Crohn’s disease. Neurogastroenterology & Motility. 2014 Aug;26(8):1200-3. [Google Scholar]
3 Chuyue DY, Xu QJ, Chang RB. Vagal sensory neurons and gut-brain signaling. Current opinion in neurobiology. 2020 Jun 1;62:133-40. [Google Scholar]
4 Fornaro R, Actis GC, Caviglia GP, Pitoni D, Ribaldone DG. Inflammatory Bowel Disease: Role of Vagus Nerve Stimulation. Journal of Clinical Medicine. 2022 Sep 26;11(19):5690. [Google Scholar]
5 Cirillo G, Negrete-Diaz F, Yucuma D, Virtuoso A, Korai SA, De Luca C, Kaniusas E, Papa M, Panetsos F. Vagus Nerve Stimulation: A Personalized Therapeutic Approach for Crohn’s and Other Inflammatory Bowel Diseases. Cells. 2022 Dec 17;11(24):4103. [Google Scholar]

 

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