Spinal cord abutment is a finding frequently noted on magnetic resonance imaging (MRI) reports, describing physical contact or “touching” of the spinal cord or the surrounding dural sac. This term indicates a structural observation rather than a clinical diagnosis of severity, representing a less forceful interaction than full compression. The seriousness of spinal cord abutment depends entirely on the degree of contact and whether it results in neurological symptoms that affect the patient’s function.
What Spinal Cord Abutment Means
Abutment describes a physical relationship where an abnormal structure is pressed up against the spinal cord without causing significant deformation or displacement. The term “abutting” implies a mild contact, contrasting with “compression,” which suggests a more substantial force and pressure on the nerve tissue. This structural finding typically arises from degenerative changes within the spine that narrow the spinal canal.
A common cause is a herniated or bulging intervertebral disc that extends past its normal boundary and makes contact with the cord. Other structures contributing to this narrowing include bony growths called osteophytes, or the thickening and hardening of the ligamentum flavum. When these structures expand, they reduce the space available for the spinal cord, leading to the observed abutment. The presence of abutment indicates potential risk, but it does not automatically confirm injury.
Severity: When Abutment Causes Symptoms
The seriousness of spinal cord abutment is determined by whether the physical contact irritates the neural tissue enough to produce symptoms, a condition known as myelopathy. Myelopathy is a disorder resulting from spinal cord damage, which can occur if abutment progresses to severe compression. Asymptomatic abutment is not considered an immediate concern, but symptomatic myelopathy is a serious condition requiring medical attention.
Symptomatic abutment, particularly in the cervical (neck) or thoracic (mid-back) spine, manifests as a progressive loss of function in the limbs below the level of contact. Patients may notice a loss of fine motor skills, experiencing difficulty with simple tasks such as buttoning a shirt, managing coins, or maintaining legible handwriting. This clumsiness often involves both hands and is a hallmark of cervical myelopathy.
Gait disturbance is another symptom, causing unsteadiness or a loss of balance that can lead to frequent tripping or an unnatural, shuffling walk. Sensory changes are also common, including numbness, tingling, or a feeling of heaviness in the arms, hands, or legs. In severe cases, the disruption of nerve signaling can affect autonomic functions, leading to issues with bowel or bladder control. If these neurological deficits are present, the abutment finding is considered serious.
Identifying the Condition and Initial Treatment
The initial step in managing suspected spinal cord abutment is to identify the anatomical structures involved and the extent of the contact. Magnetic Resonance Imaging (MRI) is the preferred diagnostic tool because it provides detailed images of soft tissues, clearly showing the spinal cord, discs, and ligaments. A Computed Tomography (CT) scan may also be used to better view bony elements, such as osteophytes, that contribute to canal narrowing.
For patients with mild or moderate symptoms, or those with asymptomatic abutment, the initial treatment is conservative management. Non-surgical care focuses on reducing inflammation, managing pain, and stabilizing the spine to prevent further irritation. Physical therapy is a primary component, aiming to strengthen the core and neck muscles to improve posture and support the spinal column.
Medications may include nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce local swelling that could be exacerbating the contact with the cord. Physicians might also recommend an epidural steroid injection, which delivers anti-inflammatory medication directly to the area to reduce nerve root irritation and swelling. This conservative approach is attempted first to see if symptoms can be resolved without more invasive procedures.
Surgical Intervention for Spinal Cord Abutment
Surgery becomes a consideration when the abutment causes severe, progressive neurological deficits or when conservative treatments have failed to relieve moderate symptoms. The goal of surgical intervention is decompression, which means creating more space around the spinal cord to relieve physical pressure. This is urgent if a patient shows signs of worsening myelopathy, such as increasing weakness or balance issues.
Various procedures are used to achieve decompression, depending on the location and cause of the abutment. A laminectomy involves removing the lamina, the back part of the vertebra, to open the spinal canal and relieve posterior pressure on the cord. A laminoplasty, typically performed in the neck, opens the spinal canal by creating a hinge on the lamina, enlarging the space without complete removal of the bone.
If a herniated disc is the sole cause, a discectomy to remove the offending disc material may be performed. These procedures are designed to alleviate the contact and allow the spinal cord to recover from chronic irritation.