Background: This case study describes the potential benefits seen in a patient suffering from Chiari malformation Grade 1 and associated neurological symptoms.

Hypothesis: Our hypothesis is that prolotherapy, combined with regenerative stabilization of the cranio-cervical junction, may have benefits in patients suffering from Chiari malformation.

Methods: This is a preliminary case report focusing on a single patient. Prolotherapy was delivered in a clinic setting. Primary outcome measures included pre- and post-treatment MRI imaging, physical benefits, and clinical observations.

Results: The patient showed marked improvement following the protocol. Repeat imaging demonstrated an improvement from Grade 1 to Grade 0, with the cerebral tonsils shifting to a normal position above the radiographic line (McRae’s line) as seen on MRI (McRae’s.

Conclusion:  Regenerative stabilization may have a beneficial effect on Chiari malformation and associated cranio-cervical instability. A clinical trial is needed to confirm safety and efficacy.

Chiari malformation [1] is a neurological condition in which the skull is too small or misshapen, forcing the cerebellum downward into the spinal canal. This can compress the brain stem and disrupt the flow of cerebrospinal fluid, leading to headaches, balance issues, and visual disturbances. Traditionally, treatment is limited to surgical decompression, which involves removing part of the skull bone [2].

Chiari malformation frequently co-occurs with connective tissue disorders such as Ehlers-Danlos Syndrome (EDS). In these patients, ligamentous weakness can lead to cranio-cervical instability (CCI), which may exacerbate or even mimic the symptoms of Chiari malformation [3]. 

Prolotherapy is a regenerative technique involving the injection of small amounts of irritant solution which is thought to stimulate growth factors and cytokines in repair [4].

This case study explores prolotherapy as a regenerative approach focusing on structural stability and tissue restoration.

This work was carried out in Greenberg Regenerative Medicine. The patient provided informed consent prior to receiving the protocol. The patient was a 59-year-old female with a history of Chiari malformation and EDS. She presented with persistent headaches, balance issues, and eye-tracking difficulties. MRI imaging confirmed a Grade 1 Chiari malformation with 5.0 mm of tonsillar descent below McRae’s line (Figure 1a and Figure 1b).

Figure 1a: Pre-treatment in 2020

Figure 1b: Magnified Pre-Treatment in 2020

Treatment involved prolotherapy targeted at the upper cervical spine and cranio-cervical junction to address identified instability. The patient was given 9 months of prolotherapy with monthly injections to all of the cervical facet capsules and the entire occiput using a 25?xtrose/1% lidocaine solution. This procedure produced a significant clinical benefit as her symptomatology of head pressure and pain had resolved. The patient was assessed by MRI scans pre- and post-treatment and by clinical signs.

Outcome

Six months following the treatment, the patient reported significant clinical improvement. Headaches and malaise were reduced by 100% and 80% respectively, and balance and eye-tracking functions returned to normal. The patient also showed a decrease in neck pain, anxiety and palpitations.

Repeat MRI imaging (post-treatment) showed a transition from Chiari malformation Grade 1 to Grade 0 (Figure 2). 

Figure 2: Post-Treatment in 2025

In the pre-treatment scan, the cerebral tonsils were evident below McRae’s line thus compressing the brain stem. In the post-treatment scan, the cerebral tonsils had shifted above McRae’s line, significantly reducing compression (Figure 2). Prolotherapy produced a significant clinical benefit as her symptomatology of head pressure and pain had resolved furthermore repeat MRI showed an improvement in Chiari Grade from 1 to Grade 0 with the cerebellar tonsils now above McRae’s line. The patient remains stable.

These data suggest that regenerative procedures focusing on the structural integrity of the cranio-cervical junction can provide a valid non-surgical alternative for the treatment of Chiari malformation. The mechanism of action may involve the stabilization of the joints and ligaments, possibly by stimulated growth factors and cytokines, which reduces the pressure on the brain stem.

This systemic regenerative effect appears to offer a tissue-restoring option that avoids the risks of invasive surgery. Prolotherapy produced a significant clinical benefit as the symptomatology of head pressure and pain had resolved, furthermore repeat MRI showed an improvement in Chiari Grade from 1 to Grade 0 with the cerebellar tonsils now above the occipital line. Further work is needed to fully assess efficacy and safety.