A herniated disc abutting the spinal cord is a diagnostic conclusion mostly seen on spinal MRI reports for back and neck pain sufferers. Alternatively, the same conclusion may be stated in any of the following language: herniated disc touching the spinal cord, herniated disc effacing the spinal cord or herniated disc encroaching upon the spinal cord.
These diagnoses are different than bulging discs which are said to compress the spinal cord or displace the spinal cord. While this may seem like semantics to some, there are some crucial differences which are vital for all patients to understand.
The actual word abutting means to rub up against. It implies contact, but not necessarily pressure or force exerted. Some disc bulges will spread passively until some other anatomical structure stops their progress. Others will expand forcibly outwards, possibly moving or pressuring other anatomical structures in their path. Abutment generally involves the less severe former variety of disc herniation.
This essay details abutment of the spinal cord by an abnormal intervertebral pathology.
Bulging discs which abut the spinal cord are usually central herniations, but can also be posterolateral herniations in some circumstances. In either case, the bulge must typically be sizable enough to allow the disc mass to touch the spinal cord, which can be clearly visualized using advanced diagnostic imaging.
Many central and posterolateral herniations are implicated in impinging on the thecal sac, but are not blamed for affecting the spinal cord itself. In cases where the cord is abutted, this is not so, since making actual contact with the spinal cord is a differentiating factor during diagnosis. However, in some cases, abutment is speculated upon, since no effect seems to be transferred to the cord and no neurological symptoms correlate. In other cases, abutment can be clearly seen through mass effect or displacement of the cord itself.
Just because a herniation touches the spinal cord does not make it inherently symptomatic. In fact, most bulging discs which touch the cord are not the source of chronic back pain. Simply making contact with the cord will not generally provide any noticeable effects to the patient, although these cases are certainly worth monitoring and have more potential to become serious health issues than herniations which do not contact the cord.
Typically, herniations which only contact the cord will not be a problem, unless other conditions exist to exacerbate the structural issue, such as osteochondral bars at the affected level or some blockage in the normal circulation of cerebral spinal fluid.
If ligamentum hypertrophy, a congenital condition or arthritic activity causes posterior canal narrowing, then a spinal stenosis condition may exist, as well.
I am far more concerned when I witness obvious and substantial displacement of the spinal cord or obvious compression of the spinal cord, particularly when the compression occurs at least partially by arthritic osteophyte formation. However, that being said, there are still many large herniations which move the cord substantially, but are not a source of pain.
I know what this diagnosis is like, since I have a few herniations in the upper back and neck which touch my cord and a very terrifying looking one in the lower cervical spine. This herniation moves my spinal cord considerably, looking like the letter C cut into the frontal face. However, although no verifiable compression seems to exist, I still get this one monitored regularly, since it could become a real problem.
Just remember that the nocebo effect of anything even theorized to be touching, contacting, abutting, impinging upon or effacing the spinal cord can be huge. Never underestimate its power, although you might feel much better when you discover just how common and often asymptomatic these disc bulges truly are.