[Chuck]

#20085

Former successful acdf 5+ years ago. Recent Auto accident findings indicate

Some images at fused site to show changes:
1)at the fused site How its possible to have thecal sac compression? In addition to spur projecting at level below it?

2) absent reflexes seemingly attributed at that same level? Bc absent bicep/s absent brachio/s? Sometimes both side sometimes one side
3)what’s Differences between terminology classification of Lesion/ Protrusion/ Herniation, and Bulge?

4) difference and meaning between radicular pain, discogenic or mechanical pain? Vs Axial and or Paroxysmal?

5) nerve compression vs cord compression and the significance there? And difference bw Cord encroachment vs cord compression?

[Donald Corenman, MD, DC]

#20093

Radiologists that note thecal sac compression (thecal sac is the “bag” that holds the spinal cord) at a prior fusion level is generally “over reading” of pathology the fusion level. If the level has been adequately decompressed but there still is some mild compression (there is room around the cord for CSF but the cord still has some effacement), this is generally acceptable but might be called as “tight” by a radiologist. It is motion that typically causes cord damage. Generally, fusion of the level with “some decompression” protects the cord from further damage.

Absent reflexes after nerve (but not cord) compression is typical. Even after decompression, reflexes might not return. With cord compression however, the physician should expect reflex increase (hyperreflexia) due to cord injury.

Lesion is a focal problem with a biological structure. Protrusion is a focal bulge of a disc. It can mean herniation or bulge. Herniation generally means a through and through tear of an annulus and nucleus protruding through this hole in the disc.

Mechanical pain is pain produced by mechanical means (you look up and develop shoulder pain every time you look up). The motion of the head causes the pain to occur.

Discogenic pain is pain that originates from the disc.

Axial pain is pain in the center of the problem area> In the neck, this is central neck pain.

Paroxysmal pain is pain that occurs generally for no apparent cause (different from mechanical pain).

Nerve compression causes radicular pain (nerve pain down the shoulder into the arm. Cord compression can be painless as the cord has no pain nerve endings. See the differences on this website under the appropriate categories (myelopathy for cord compression and radiculopathy for nerve compression).

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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