rypz79ParticipantMarch 23, 2020 at 3:03 pmPost count: 8
Hello Dr. Corenman,
I’ve read in this blog
That fibrillation is only seen when there is an axonal injury. Thus when there is no indication of fibrillation on the EMG test it’s likely to be damage to the myelin sheath only.
1) Is that correct? Couldn’t find any reference for that in your article
2) Is Neurapraxia essentially an interruption in the conduction of the impulse down the nerve fiber due to myelin sheath damage only with no axonal damage involved?
3) Can / is it common for Neurapraxia to occur due to a compression from disc herniation with symptoms of radiculopathy?
4) With almost no motor loss do you recommend me doing an EMG/NCV test (the surgeon told me couple of days after the surgery that it’s irrelevant)?
Thank you very much Dr. CorenmanDonald Corenman, MD, DCModeratorMarch 25, 2020 at 3:18 pmPost count: 7400
Fibrillation potentials (FP) or positive sharp waves (PSW) only occur 2-3 weeks after nerve root injury. If there is no conduction to the muscle fiber, it will be come irritable and develop these FPs and PSWs. It does not matter why the disconnection occurs.
Myelin sheath damage is actual damage to the nerve. This is how multiple sclerosis works.
Since 80% of herniations that cause motor deficit respond (recover) with decompression, I could use that percentage to talk about axonotmesis of 20% of the nerve cells but I have never differentiated gluteus medius recovery from tibialis anterior recovery. That could further differentiate neurapraxia from axonotmesis and neurotmesis.
Dr. CorenmanPLEASE 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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