It is often claimed by the IME doctor is that bulges or herniations of intervertebral discs are clinically irrelevant in the absence of any evidence that there is any impingement on a nerve root for the spinal cord. This premise is simply contrary to the medical literature.
Jinkins, et.al, "The Anatomic Basis of Vertebrogenic Pain and the Autonomic Syndrome Associated with Lumbar Disc Extrusion", American Journal of Roentgenology, June 1989, p. 1277 et. Seq. identifies “the vertebrogenic symptom complex which involves "referred pain" eminating from the injured disc through the autonomic nervous system.
Freemont, et. Al. "Nerve Growth into Diseased Intervertebral Disc in Chronic Back Pain”, The Lancet 1997;350;178-81 explains that injuries to the outer third of the annulus fibrosus of the disc can cause the ingrowth of painful nerve fibres which extrude chemical substance causing pain plays an “important role in the pathogenesis of chronic low back pain”.
Bogduk et al, "The Innervation of the Cervical Intervertebral Disc", spine, Vol 13, No.1, pp. 1-8 (1987) states that “there been no doubt that lumbar intervertebral discs are innervated…(and) the innervation is not just in their superficial layers but can be found as deep as the outer third of the annulus fibrosus” so that disc injuries that do not impinge on a nerve root or the spinal cord can be expected to be painful. This article states that studies have shown that the same is true of cervical discs, i.e. that injury to the disc can cause pain.
Douglas E. Schmidt
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