uprightdoc wrote:Your welcome Nigel. Buldges invade and decrease the epidural space which contains the vertebral veins. Bending the neck forward further decreases the space. Disrupting venous flow can lead to chronic ischemia and edema. Buldges can also irritate local tissues and cause inflammation. Sometime the dura mater of the nerve roots become adherent to buldges and ostophytes due to chorinic inflammation resulting in local segmental tethering. Buldges also act as fulcrums when the the head bends forward. Fulcrums and tethering caused by buldges can increase tension and irritation of the cord and nerve roots.
The spinal cord has been studied as a co-axial cable with blood and CSF flowing through it at different rates. I further propose that the spinal canal is a tri-axial tube with veous blood surrounding the cord. Spondylosis, stenosis and scoliosis affect blood and CSF flow through the tri-axial tube.
It is interesting that the L'Hermitte's sign and the trigeminal neuralgia disappeared but everything else appears worse, including: fatigue, temperature, vision and cognition issues, as well as lower body weakness. Keep me posted on the one year assesment and suggested protocol changes.
uprightdoc wrote:I would treat you according to what I find. I would consider cervical traction in your case with prepatory and follow up physioltherapy. If you do consider cervical traction you need to find a high quality piece of equipment that can control the angle, strength and duration of the pull, as well as length of treatment. Before considering traction, you need to be checked for possible local tethering of the cord such as L'Hermitte's sign as well as upper and lower extremity adverse mechanical tension tests. You should also be checked for upper motor nerve signs. In addition manual and mechanical types of traction, flexion-distraction and craniosacral I would also use different types of electrotherapy on your weak muscles and I would work on your sensory and proprioceptive nerves for balance.
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