Physiology of Spinal Cord, Nerve Root and Peripheral Nerve Compression

¹ From the Department of Neurology and Neurosurgery, New York Medical College, New York City

The reversible conduction block produced by maintained mechanical pressure around small segments of spinal cord, nerve root or peripheral nerve (dog) is due to mechanical deformation of the neuronal tissue and not to lack of O₂. The compressed segment, although ischemic, is not anoxic; O₂ from adjacent nonischemic tissue reaches it, presumably by diffusion. The entire pattern of modification of neuronal responses by compression and the postdecompression recovery pattern are distinctly different from the patterns observed during anoxia and recovery from the latter, indicating the difference in mechanisms by which mechanical deformation and O₂ lack block conduction. The largest fibers in dorsal columns, roots and peripheral nerves are most susceptible to pressure and the smallest ones are relatively most resistant. Secondary neurons are less vulnerable than the primary afferent ones to light and moderate, but suprasystolic, circumferential spinal cord pressure. All components of the composite spinal cord potential are blocked at about the same time by larger compressive forces. Anoxia, on the other hand, always inactivates secondary neurons before dorsal column fibers and blocks smaller A fibers in peripheral nerves before the larger ones. The latency for complete blocking in each neuronal structure is specific and irreducible in the case of anoxia, whereas in compression it varies over a wide range, depending upon the magnitude of the compressive force.