Intraspinal dural distraction inciting spinal radiculopathy: cranial to caudal and caudal to cranial.

LaBan previously described the precipitous onset of lumbar radiculopathy in 12 patients who were receiving therapeutic, intermittent cervical traction for a primary complaint of cervical radiculopathy. Cranial-to-caudal traction of the intraspinal pia with cervical spine distraction was cited as the dynamic link believed to have provoked the lumbar radiculopathy. This present communication adds an additional case and describes an equal but opposite occurrence, a case of caudal-to-cranial dural distraction that provoked cervical radicular pain. In this instance, the complaint of elbow pain associated with a cervical radiculopathy could be attributed to caudal-to-cranial intraspinal pia traction acting on its intraforaminal thecal extension surrounding the C8 spinal root, previously sensitized by a herniated disc.