Cord impingement occurs when pressure on the spinal cord or its branching nerves disrupts normal signaling between the brain and body, affecting movement, sensation, and overall function. This condition involves mechanical forces compromising neurological integrity within the spinal column.
What is Cord Impingement?
The spinal column, composed of individual bones called vertebrae, forms a protective channel for the spinal cord. Between these vertebrae are intervertebral discs, which act as cushions and allow for flexibility. The spinal cord is a thick bundle of nerves running from the brain down through the spinal column, serving as the nervous system’s main communication highway. Nerve roots branch off the spinal cord at each vertebral level, exiting the spinal column to innervate different parts of the body. The specific location and degree of compression determine the severity and type of symptoms experienced.
Causes of Cord Impingement
Cord impingement often arises from age-related wear and tear on the spine, leading to structural changes that narrow the spinal canal. A common cause is a herniated disc, where the soft center of an intervertebral disc pushes through its outer layer. This bulging or ruptured disc material can press on the spinal cord or nearby nerve roots, causing localized or radiating symptoms. The disc material might also release inflammatory substances, irritating the nerves.
Bone spurs (osteophytes) are another frequent contributor to compression. These bony growths develop as the body attempts to stabilize a spine affected by degenerative changes. If these spurs grow into the spinal canal or foramina (openings where nerves exit), they can impinge on the spinal cord or nerve roots. This process often accompanies conditions like osteoarthritis of the spine.
Spinal stenosis, a narrowing of the spinal canal itself, is a cause of cord impingement. This narrowing can result from the thickening of ligaments, bone spurs, or bulging discs, all reducing the space available for the spinal cord. Degenerative disc disease, characterized by the gradual breakdown of the intervertebral discs, frequently precedes these issues, as disc dehydration and collapse can lead to instability and subsequent bone spur formation or disc herniation. Traumatic injuries, such as fractures or dislocations of the vertebrae, can also acutely compress the spinal cord or nerve roots.
Signs and Symptoms
The signs and symptoms of cord impingement vary widely depending on the specific location and severity of the compression. Pain is a common presentation, localized to the impingement area, such as the neck or lower back. This pain often radiates along the path of the compressed nerve, extending into the arm, hand, leg, or foot. Pain can range from a dull ache to sharp, burning, or electric-shock sensations.
Numbness and tingling are often described as a “pins and needles” sensation in the affected limb or body region. This sensory disturbance occurs because compressed nerves cannot transmit normal sensory signals to the brain. Muscle weakness can also develop, making it difficult to perform routine tasks, like lifting objects or walking steadily. Over time, sustained nerve compression can lead to muscle atrophy, where affected muscles visibly shrink due to lack of proper nerve stimulation.
Coordination issues and balance problems may arise, especially with impingement in the cervical (neck) or thoracic (mid-back) regions, affecting motor control pathways. This can lead to difficulty with fine motor skills like buttoning a shirt or maintaining gait. In severe cases, especially with spinal cord compression, individuals may experience bladder or bowel dysfunction, which requires immediate medical attention.
Diagnosis and Treatment Options
Diagnosis begins with a physical examination and medical history review. The physician conducts a neurological assessment to evaluate reflexes, muscle strength, sensory perception, and gait, to pinpoint the likely nerve involvement. This initial assessment guides further diagnostic steps to identify the compression source.
Imaging tests visualize the spinal structures and confirm impingement. Magnetic Resonance Imaging (MRI) is the preferred imaging modality, providing detailed images of soft tissues, including the spinal cord, nerve roots, and intervertebral discs. Computerized Tomography (CT) scans also visualize bone structures more clearly, such as bone spurs or fractures. X-rays may be taken to assess overall spinal alignment and identify any degenerative changes, but do not show soft tissue compression.
Treatment approaches for cord impingement are tailored to the individual, considering the cause, severity of symptoms, and overall health. Non-surgical methods are attempted first to alleviate pressure and manage pain. Rest from aggravating activities reduces inflammation and aids healing. Physical therapy is recommended to strengthen surrounding muscles, improve flexibility, and enhance posture, to decompress affected nerves.
Medications are prescribed to manage pain and inflammation. Over-the-counter pain relievers (e.g., ibuprofen, naproxen) are for mild discomfort; prescription anti-inflammatory drugs or muscle relaxants may be necessary for more severe symptoms. Epidural steroid injections, delivered into the space around the spinal cord, can provide temporary relief by reducing inflammation around compressed nerves. These injections are performed under imaging guidance for precise placement.
If non-surgical treatments do not provide sufficient relief or if neurological deficits worsen, surgical intervention may be considered. The general goals of surgery are to relieve pressure on the spinal cord or nerve roots and, in some cases, to stabilize the spine. Procedures might involve removing the herniated disc material (discectomy), trimming bone spurs, or widening the spinal canal (laminectomy). The decision to pursue surgery is made collaboratively between the patient and their medical team, weighing the potential benefits against the risks.