Orthopedics-Online

Nerve root compression

definition

A Nerve root compression describes the mechanical irritation of the Root of a spinal nerve in the area of the spine. That in medicine as "Root Compression Syndrome" The clinical picture described is characterized by its typical back pain, as well as the Radiation of pain into the body region supplied by the nerves. But it can also Muscle weakness and Signs of paralysis entail.

Read more on the subject here Back pain

causes

One Root compression syndrome can various causes underlie. For example Vertebral body fractures or Vertebral arch fractures, but also Bleeding (Hematomas) or infectious processes lead to pinching of spinal nerve roots. In overall very rare cases, a tumor, for example the membranes of the spinal cord, cause root compression.

However, by far the most nerve root compressions will come through degenerative processes, so Due to wear and tear and age conditions. Changes in the bony structures of the spine as well as its soft tissues can be subject to these changes. Among other things, a arthrosis of the small vertebral joints directly or through the subsequent bone formation to one Narrowing of the intervertebral hole through which a spinal nerve emerges.

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Even more common, however, are Herniated discs as a trigger Nerve root irritation to make out. Here, the outer fiber ring of an intervertebral disc can no longer stabilize the centrally located gelatinous nucleus, so that it bulges and exerts pressure on neural structures. Understandably the pressure on the structures increases the spine with increasing distance to the head (at least when standing and sitting) steadily until he at the level of the lumbar spine be maximum reached. The spine has partially adapted to this load, so that the diameter of the vertebrae and intervertebral discs steadily increases towards the legs. Nonetheless, the large part the nerve root compressions in the loin area on.

Read more on the subject here disc prolapse

Symptoms

The Leading symptom the compression of spinal nerve roots are primarily theirs characteristic pain. If the damage to the nerve root is already advanced, further symptoms appear Sensitivity disorders in the respective dermatome on. As such, the Skin areas denotes which are supplied by a spinal nerve. Above all, these sensory disorders belong to the above Numbness, tingle or Temperature sensation disorders.

Severe nerve root compression also leads to damage the one lying in the center of the nerve motor fibers. This has a weakness the one he supplied Muscles result, being here mostly the leg muscles is affected. At the same time one results Weakening of the muscle reflexes. Very severe forms of root compression syndrome can even Signs of paralysis entail. Depending on the level of nerve root compression in the spine you can advanced nerve damage also a Urinary incontinence or fecal incontinence entail. Both incontinence and symptoms of paralysis medical emergencies and need one fastest possible treatment!

The symptoms of nerve root compression can be similar to those of one Nerve root inflammation be very similar. Therefore, nerve root inflammation is an important diagnosis that cannot always be clearly distinguished from compression.

Nerve root compression pain

The nerve root compression syndrome is mainly due to its characteristic back pain marked. He's going through Inflammatory processes triggered as part of the compression of the nerve tracts and usually as burning or pulling described. In addition shine he typically in the Skin areas (Dermatomes), which are sensitively supplied by the affected spinal nerve. Because most of the root irritation at the level of the lumbar spine occur, this means pain in the leg area for the patient in the majority of cases. Because these are innervated by the spinal nerves exiting here. By unusual movements The symptoms also usually increase. They can also get through Sneeze, to cough or Crunches typically provoked or reinforced. This is because the pressure increases within the abdominal cavity and thus also on the structures of the spine, thus increasing the compression of the nerve roots.

diagnosis

As already mentioned, root compression of the spinal nerves is characterized by their characteristic symptoms out. Based on this alone, the appropriate Suspected diagnosis can be asked with a high degree of certainty. A thorough one physical examination can further help to confirm the suspicion. Here is above all the so-called Lasègue test decisive. In this case, the patient's extended leg, who is lying on his back, is raised. If there is pain shooting from the back into the leg up to an angle of 45 °, the test is considered positive. A final diagnostic confirmation is ultimately carried out imaging procedures, especially the Magnetic resonance imaging (MRI) or the Computed tomography (CT).

Some Symptoms, Symptom complexes and trigger nerve root compression should always be one as soon as it is noticed at the time of diagnosis prompt treatment entail. They are called "Red Flags" and provide information serious disease courses or -circumstances This includes about an accident as the cause for root compression syndrome, as well Fecal incontinence and Voiding disorders. Likewise belong fever, Night sweats, unwanted weight loss lately and other references to a Tumor disease to the Red Flags.

Therapy of nerve root compression

If the diagnosis of root compression syndrome has been made, a subsequent treatment depend on the exact cause of the disease. A very large part of the root compressions is going through Herniated discs caused. This can happen in over 90% of the cases conservative, this means non-operational, be treated. Above all, there is one adequate pain management a role. With their help the patient should after the diagnosis Exercise again as soon as possible float, move and with the physical therapy kick off.

A surgical intervention Treatment of the disease is particularly suitable if all previous conservative treatment attempts unsuccessful stayed or serious symptoms occur. A degenerative change in the small vertebral joints (facet joints) is also typically treated conservatively. Play here too Pain- and physical therapy a major role. Expanding a local anesthesia and Anti-inflammatory by the Injection of local anesthetics and Glucocorticoids respectively.

Read more on the subject here Therapy for a herniated disc

Definitely have to be treated surgically, however Bleeding, Tumors and Vertebral body fractureswhich lead to neurological failure symptoms. Infections are also sometimes treated surgically if they lead to the formation of abscesses. If this is not the case, only antibiotic therapy is carried out instead.

Duration

Nerve root compression is a potentially serious disease, the course of which is difficult to predict in many cases. Even if the majority of patients do not require surgical therapy, complaints and other restrictions in everyday life often last for several months. In order to keep the duration of the illness itself and the duration of the incapacity for work as short as possible, it is particularly important to strictly adhere to the therapy regimen. Regular exercise, an upright and gentle posture, as well as avoiding lifting heavy loads are essential points here. They also guarantee the best possible protection against relapses and any associated surgical intervention.

Also read: Duration of a pinched nerve

Lumbar spine nerve root compression

The spinal nerves emerging from the spinal cord systematically pull into all regions of the body (with the exception of parts of the head) and give us our tactile sensitivity and the ability to control our skeletal muscles. This becomes very clear when you look at the sensitive supply of the skin. It can be divided into clearly delimited skin areas, the so-called dermatomes, which are each supplied by a spinal nerve. The spinal cord nerves exiting at the level of the lumbar spine (lumbar spine) supply the front and sides of our legs in particular, as well as the flanks and loins.

A nerve root compression of these spinal cord nerves leads accordingly to deficits of the tactile sensation in these skin areas. In many cases this is simply noticeable as numbness or as tingling and temperature sensation disorder. More serious nerve root damage also leads to a disruption of the innervation of the muscles. This results in a reduction in muscle reflexes, muscle weaknesses and paralysis, especially in the thigh muscles, but also in the muscles of the lower leg and feet, depending on the precise location of the root compression.

Read more about this under

Herniated disc at level L4 / L5
L5 syndrome
Herniated disc of the lumbar spine

Nerve root compression of the cervical spine

As with the rest of the body, there are so-called dermatomes in the area of the upper extremities - areas of skin that can be sharply delimited from one another and only from one pair of spinal nerves each are supplied. This comes into play when diagnosing nerve root compressions in the cervical spine (cervical spine). Depending on, at what level the cervical spine has been damaged, the characteristic symptoms of this disease can be seen in the various dermatomes of neck, shoulder and Poor determine.

A herniated disc leads to C7, so above the 7th cervical vertebra, too Sensory disturbances in the area of Middle and index fingers, of Back of hand, as well as the Back of upper arm and forearm. These include above all Numbness, tingle and Temperature sensation disorders. More serious damage to the nerve root, for example due to compression that has existed for a long time, also leads to motor failure symptoms certain muscle groups in the arms and shoulders.