Cervical spine thecal sac impingement
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Degenerative disease affecting the spine is a major cause of chronic disability in adults.
Pain can originate from bone, joints, ligaments, muscles, nerves, and intervertebral disks, as well as paravertebral tissues. Most neck pain responds to conservative therapy, but if the pain is severe, or associated with a radiculopathy or myelopathy, a more aggressive approach is needed.
Magnetic resonance imaging is the diagnostic procedure of choice.
The normal intervertebral disk consists of a central nucleus pulposus surrounded by a tougher outer ring, the anulus fibrosus. Picture a jelly doughnut. Normal disks are well hydrated, the nucleus containing 80 to 85% water and the anulus about 80% Together with the end plates of the adjacent vertebral bodies, the disk forms a disk complex that gives structural integrity to the this space and cushions the mechanical forces applied to the spine.
With aging, biochemical and structural changes occur in the intervertebral disks. The water content decreases down to 70%. The vertebral end plates also become thinner.
Development of tears weakens the anulus and allows the nucleus to protrude into the defect. Fissures - small cracks- develop in the cartilaginous end plates.
Cervical disk disease occurs most commonly at the levels of C5-6 and C6-7. A central disk herniation will sometimes cause a myelopathy due to cord compression, along with neck pain and stiffness. If the disk extends laterally to compress nerve roots, the pain may radiate to the shoulder, arm, or hand.
Using MRI, it is possible to determine if there is disk extrusion that impinges on the thecal sac that serves as a container for cerebrospinal fluid and the spinal cord.
Herniated disks can be midline or lateral, and it is important to clearly identify the location of the disk fragment to aid the neurosurgeon. Midline abnormalities can be identified on certain views on the MRI image by seeing impingement on the thecal sac or cord.
Indentation or compression of the cord is common with larger disks and is seen best on sagittal images (imagine cutting a patient down the middle of their body so that there is a right half and a left half- that's a sagittal cut). When either herniated disks or bony spurs (osteophytes) impinge on the spinal cord, injury can occur, which leads to the importance of prompt, accurate diagnosis and aggressive therapy.
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