Expert: Dr. J. Shawn Leatherman - 8/17/2006

Question
Dr. Leatherman, thanks for the great response...quick too.  Just one more question, if I cannot find a spine research chiropractor, where else shoulds I look.  
Thankyou, Jeff.
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Followup To

Question -
I was involved in a car accident a fwe months back and have had some serios back pain that can go down my back to my butt and thigh.  I just had an MRI test and the doctor told me that it was negative except for -fibrous adhesions visualized on the thecal sac and dentate ligamentts.   

He gave me antiinflammation drugs, muscle relaxers and a cortizone shot in my back.  It helped a bit -2 days- but I don't understand what that all means.  Shouls I go see a chiropractor for this?


Answer -
Dear Jeff,

Concerning your MRI, this diagnostic imaging test is utilized to visualize soft tissue.  When performed on the spine, the specific anatomy targeted for visualization is the spinal cord, the nerve roots, the disc, the ligaments of the spinal column and the muscles.  You had mentioned that your results were negative.  This means that no disc derangement was found/visualized or spinal canal stenosis, (thinning of the space in which the spinal cord is housed).

The fibrous adhesions you spoke of happen when there is reduced movement in an area due to previous injury or prolonged abnormal movement patterns.  Fibrous adhesions are fancy descriptions of scar tissue.  These adhesions will limit the movement of the structures they are associated with and can be a source of decreased pain and dysfunction.  In this case the thecal sac and the dentate ligaments.

The thecal sac is a name given to the outer covering of the spinal cord.  It is divided into three distinct layers called the dura matter, the arachnoid matter, and the pia matter.  Collectively these are also known as the meninges.  This is the tissue that becomes inflamed/infected in meningitis.  This tissue, (thecal sac), surrounds the cord and contains the cerebral spinal fluid which helps protect the spinal cord.  

The dentate ligaments are small structures that attach from the inner most level of the thecal sac (the pia matter) and connect to the outer most level of the thecal sac (the dura matter).  Their purpose is to help suspend the spinal cord within the thecal sac.  The dentate ligaments extend from the top of the spine down to about the T12/L1 level of the spine.  Because of their anatomical location, it is unlikely that the dentate ligaments are a source of your pain….they are higher up in your back, approximately 4-5 inches above the belt line.

Jeff, I do think you should get examined by a chiropractic physician.  Your pain most likely is arising from the facet joints, inflammation of the nerve roots, or the sacroilliac joint, [the joint formed by the side of your pelvis and the bottom of the spine (the sacrum)].  It is common to have localized pain across the beltline, into the buttock and down the thigh from these structures.  You may also have irritation of the sciatic nerve at the nerve root level or where it course through a muscle in the buttock called the Piriformis muscle.  Frequently sciatic type pain will extend below the knee as well.

Chiropractic adjustments are performed in a manner to take pressure off the facet and sacroilliac joints. This reduces inflammation, pain, and sends neurological impulse to the spinal cord and brain which reduce muscle spasm and will increase the local blood flow in the area to aid in the removal of chemical irritants as well as bring increased nutrients to the area for tissue repair.  The Spine Research Institute of San Diego has a great website for more information on vehicle crashes, and you can look up physicians who have been through their program for a doctor with advanced credentials and qualifications in treating these types of injuries.  www.srisd.com

Good Luck.
Respectfully,
Dr. J. Shawn Leatherman


Answer
Dear Jeff,

Check out my website at www.suncoasthealthcare.net.  There are links to other professional organizations in chiropractic that will help you find a qualified chiropractic physician in your area.  If you cannot find someone in your locale, e-mail me personally through the website address and I will help you find a good chiropractor through my connections with other physicians.

Respectfully,
Dr. J. Shawn Leatherman