Dermatomes: Definition, chart, and diagram

Dermatomes are areas of skin that send signals to the brain through the spinal nerves. The dermatome system covers the entire body from the hands and fingers to the feet and toes.

The part of a nerve that exits the spinal cord is called the nerve root. Damage to a nerve root can trigger symptoms in the nerve’s corresponding dermatome.

Below, we show the locations of the dermatomes throughout the body. We also describe health conditions that can damage the spinal nerves and affect their dermatomes.

Share on PinterestVarious health problems damage the spinal nerves and affect the surrounding skin.

A dermatome is an area of skin that sends information to the brain via a single spinal nerve.

Spinal nerves exit the spine in pairs. There are 31 pairs in total, and 30 of these have corresponding dermatomes.

The exception is the C1 spinal nerve, which does not have a corresponding dermatome.

The spinal nerves are classified into five groups, according to the region of the spine from which they exit.

The five groups and their points of exit from the spine are:

1. Cervical nerves: These exit the neck region and are labeled C1–C8.
2. Thoracic nerves: These exit the torso region and are labeled T1–T12.
3. Lumbar nerves: These exit the lower back region and are labeled L1–L5.
4. Sacral nerves: These exit the base of the spine and are labeled S1–S5.
5. A coccygeal nerve pair: These exit the tailbone, or coccyx.

Each dermatome shares the label of its corresponding spinal nerve.

Some dermatomes overlap to a certain extent, and the precise layout of the dermatomes can vary slightly from one person to the next.

Below, we list the locations of the dermatomes that correspond to the spinal nerves in each group.

Cervical nerves and their dermatomes

• C2: the base of the skull, behind the ear
• C3: the back of the head and the upper neck
• C4: the lower neck and upper shoulders
• C5: the upper shoulders and the two collarbones
• C6: the upper forearms and the thumbs and index fingers
• C7: the upper back, backs of the arms, and middle fingers
• C8: the upper back, inner arms, and ring and pinky fingers

Thoracic nerves and their dermatomes

• T1: the upper chest and back and upper forearm
• T2, T3, and T4: the upper chest and back
• T5, T6, and T7: the mid-chest and back
• T8 and T9: the upper abdomen and mid-back
• T10: the midline of the abdomen and the mid-back
• T11 and T12: the lower abdomen and mid-back

Lumbar nerves and their dermatomes

• L1: the groin, upper hips, and lower back
• L2: the lower back, hips, and tops of the inner thighs
• L3: the lower back, inner thighs, and inner legs just below the knees
• L4: the backs of the knees, inner sections of the lower legs, and the heels
• L5: the tops of the feet and the fronts of the lower legs

Sacral nerves and their dermatomes

• S1: the lower back, buttocks, backs of the legs, and outer toes
• S2: the buttocks, genitals, backs of the legs, and heels
• S3: the buttocks and genitals
• S4 and S5: the buttocks

The coccygeal nerves and their dermatome

The dermatome corresponding with the coccygeal nerves is located on the buttocks, in the area directly around the tailbone, or coccyx.

Symptoms that occur within a dermatome sometimes indicate damage or disruption to the dermatome’s corresponding nerve. The location of these symptoms can, therefore, help doctors diagnose certain underlying medical conditions.

Some conditions that can affect the nerves and their corresponding dermatomes are:

Shingles

Shingles, or herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus. This is the same virus that causes chickenpox.

After the body recovers from chickenpox, the virus can lie dormant and eventually reactivate as shingles.

In adults, shingles typically causes a rash to form on the trunk, along one of the thoracic dermatomes. The rash may be preceded by pain, itching, or tingling in the area.

Some other symptoms of shingles can include:

• a headache
• sensitivity to bright light
• a general feeling of being unwell

A person with a weakened immune system may develop a more widespread shingles rash that covers three or more dermatomes. Doctors refer to this as disseminated zoster.

Pinched nerves

A pinched nerve occurs when a nerve root has become compressed by a bone, disc, tendon, or ligament. This compression can occur anywhere along the spine, but it usually occurs in the lower, or lumbar, region.

A pinched nerve can cause pain, tingling, or numbness in its corresponding dermatome. As such, the location of the symptoms can help a doctor identify the affected nerve.

The doctor then diagnoses and treats the underlying cause of the pinched nerve and recommends ways to relieve the symptoms.

Traumatic injury

A traumatic injury to the nerves may result from an accident or surgery.

The severity of symptoms can help doctors determine the extent of the nerve injury.

Dermatomes are areas of skin, each of which is connected to a single spinal nerve. Together, these areas create a surface map of the body.

Dysfunction or damage to a spinal nerve can trigger symptoms in the corresponding dermatome. Nerves damage or dysfunction may result from infection, compression, or traumatic injury.

Doctors can sometimes use the severity of symptoms in a dermatome to determine the extent and location of nerve damage. They then work to diagnose and treat the underlying cause of the damage.

L2-L3 Treatment Of Disc Bulge, Nerve Pain & Slip Disc

Holistic L2-L3 treatment through advanced methodology & technology for a disc bulge, nerve pain & slip disc now available at CSC.  Our award-winning center offers collaborative treatment with advanced methods of NSD Thrapy® will give you lasting relief from L2-L3 pain. If you suffer from a slipped disc (bulging, herniated, protruded, prolapsed & extruded disc), we can help. Let our experts get you back to healthy, active life.

The L2-L3 spinal segment requires a specialized set of skills and methods for complete recovery with lasting effects. Contact one of our centers near you today.

Have You Been Diagnosed with Slip-Disc At L2-L3?

Slip-disc at L2-L3 is descriptive of a spinal disc disorder of the upper lumbar spine. TheFacet L2-L3 disc is about 2 inches above the waist. Problems at the L2-L3 segment of the lumbar spine commonly refer to pain in the spine’s mid or lower portions.

Some may even experience pain in the flanks or the inner parts of their thighs. However, if the L2-L3 slip disc is severe enough, it can cause pain anywhere from the waist down to the toes. In this article, we will provide a brief overview of slip-disc in hopes of providing our patients with the needed information. Please feel free to share this page with friends and family members in need.

The lumbar spine consists of 5 spinal bones named lumbar vertebrae. They are labeled L1 to L5, with L1 being the first vertebra of the lumbar spine and L5 being the bottom-most vertebra in the lumbar spine. The slip-disc incidence in the lower lumbar segments such as L3, L4, and L5 is far more common than in the upper portions of the lumbar spine. There are a few theories that explain the higher incidence of slip-disc in the lower lumbar spine.

Why Did You Get A Slip-Disc Or Slipped Disc?

There are several reasons for a slipped disc in the lumbar spine. We have listed these theories for you below:

• Poor posture: Poor posture is the leading cause of spinal disc damage, including damage to the L2-L3 segment.
• Increased discal pressure: Prolonged sitting or excessive bending at the waist leads to increased intradiscal pressure. Increased disc pressure is the leading cause of spinal disc degeneration.
• Improper lifting: Lifting heavy items or lifting while bending at the waist places excessive stresses along spinal joints and spinal discs, leading to tears and even slippage of spinal discs or spinal bones.
• Neglect of a minor back issue: Neglecting the so-called normal backache is a leading cause of spinal disc issues.
• Hereditary predisposition: Congenital issues play a critical role in spinal health. Most common congenital problems that cause spinal disc issues in the lumbar (L1-L2, L2-L3, L3-L4, L4-L, or L5-S1) include scoliosis, lumbarization, sacralization, or pelvic unleveling.
• Lumbarization: The lumbar or low back has five segments. Lumbarization occurs when there are more than five segments. It results when the first segment of the tailbone (sacrum) takes on the lumbar vertebrae’s characteristics.
• Sacralization: You have sacralization when you have less than five segments in the low back. In sacralization, the last lumbar section takes on characteristics of the tailbone or sacrum.

Now that we have covered the reasons for pain or slipped disc at the L2-L3 segment, let’s look at why the low back is predisposed to injuries or pain:

Why Your Low Back Is Painful Or Easily Hurt?

Nowadays, back pain is a common occurrence. Pain in the low back means that one or more tissues or structures in the lower back are not working correctly. While there are many reasons, poor sitting posture ranks as the number one causative issue. A poor sitting posture places enormous stress on joints, muscles, ligaments, and discs (disk) of your spine. A habitual poor sitting posture is the leading cause of premature degenerative changes and slipped discs. The primary reasons argued as causes are many. In general, the back is predisposed to damage, and pain is related to the spine’s supportive functions. We have listed some of them below:

1. Load-bearing: The lumbar spine is the most weight-bearing of all spinal segments Mobility: Lower back portions of your spine allow for bending, twisting, and tilting backward.
2. Center of the body: The low back or the lumbar spine is at the center of your body. It connects the upper body and lower body through the trunk and lumbar spine.
3. Shearing force: Another argument is that an increased shearing force at the lower segments of the lumbar spine is due to the lordotic curvature.

Therefore, the lower lumbar spinal discs are more prone to injury with the upper body’s weight on these segments.

What Are The Common Spinal Issues In Patients With An L2-L3 Disc Problem?

We have listed the most common conditions reported on MRI films of patients that have L2-L3 spinal disc issues below:

• Degenerative changes within the spinal disc known as desiccated or degenerated disc
• A bulging disc (early stage of a slipped disc)
• Protruded, prolapsed, herniated, or extruded spinal disc (slipped disc)
• Hypertrophy of Ligamentum flavum, a leading cause of spinal canal stenosis or shrinkage
• Facet hypertrophy, facet degenerations, or facet arthritis (degenerative and arthritic changes in spinal joints)
• Facet inflammation (swelling within spinal joints), a leading cause of back pain
• Canal Stenosis (shrinkage of the canal that houses the spinal cord or the thecal sac)
• Foraminal Stenosis (narrowing of the openings between two spinal bones), causing nerve impingements or nerve root compression
• Nerve root compression (when the exiting spinal nerves get compressed from a slipped disc, arthritic or thickening of ligaments that surrounds a joint)

Patients may also see some of the following condition reported on their MRI:

1. Spondylosis: A combination of generative changes, slipped disc, and arthritis
2. Spondylolisthesis grades 1-4: These are forward slippage of spinal bones. Grade I (one) is a slight slippage. Complete or severe slippage is a Grade IV (four)
3. Modic changes: These are vertebral degenerative changes that result from injury or inherited or congenital issues. These changes are reported as Modic I, II, or III

These are the most widely recognized MRI readings if there should arise an occurrence of an L2-L3 disc. Symptoms are dependent on the severity of nerve compressions. However, some individuals present with moderate nerve compression but yet still live pain-free.

Symptoms Of L2-L3 Disc Problem

The primary symptom includes back pain. You may also experience pain, weakness, numbness, tingling, or burning sensations in front of your thigh. The second lumbar nerve originates from the L2-L3 interspace. It controls the upper portions of your low back, thighbone, and the muscles at the thigh’s front. Good examples of muscles controlled by the l2-l3 nerve are the Quadratus lumborum and Iliopsoas muscle.

Both of these muscles are in charge of keeping you in an upright posture. Pain, numbness, tingling, or burning sensations are common when the l2-l3 nerves are compressed, irritated, or damaged. Also, internal organs can malfunction when problems occur at the L2-L3 spinal segment. For example, problems in the upper lumbar spine can result in back pain, leg pain, leg weakness, leg tingling (numbness), constipation, colitis, and diarrhea.

L2-L3 Facet Hypertrophy & Facet Mediated Pain

Facet mediated pain at L2- L3 results from degenerative changes in spinal joints. It is a condition in which the spinal joint is the sole contributor to the aches and pains you feel in your back. Facet hypertrophy, which results from thickening and degenerative changes of spinal joints, is a leading cause of facet mediated pain.

Facet mediated pain is treatable and recoverable without surgery or injections. However, some surgeons may recommend steroidal injections and radiofrequency ablation. Radiofrequency ablation is a minimally invasive spine surgery designed to destroy and kill the pain sensing nerve in your spinal joints. Incidentally, this pain sensing nerve in your spinal joint is called the medial branch nerve.

The medial branch nerve senses pain and controls ligaments and spine stabilizing muscles known as the multifidus muscles. In short, radiofrequency ablation or RFA surgery may lead to damage to your spinal muscles, destabilizing the entire spine. Therefore, we encourage a non-invasive approach to facet mediated pain caused by facet hypertrophy. The best alternative to spinal joint surgical procedures or steroidal injections is a combination of chiropractic and physiotherapy. Learn more about your non-invasive options when you visit a Chiropractic Specialty Center® near you before going through radiofrequency ablation surgery.

What Are the Most Common Spine Conditions Seen in The Lower Back?

Back pain is common. Everyone will develop some degree of back pain in life. Because of its general nature, sufferers often neglect or dismiss mild back pain. However, continued or recurrent backaches or pain can lead to significant health issues. Therefore, take our advice and do not neglect your pain.

Moreover, back pain is the leading cause of disability. The most common site of back pain is the lower back. Daily stresses and poor posture is the leading cause of back discomfort. In addition, the lower back or the lumbar spine is a common site for:

• Bones spurs in spinal bones or joint (bone spurs at spinal joints is referred to as facet hypertrophy or facet arthritis)
• Subluxations (misalignments of spinal bones at L2-L3 resulting in pinched nerves),
• Spinal disc degenerative changes,
• Hypertrophy of ligamentum flavum
• Spinal disc bulge & disc herniations
• Extruded spinal discs (extrusions),
• Fragmentation (fragmented spinal discs)
• Spinal canal stenosis

Conservative treatment is your best option for an L2-L3 spinal segment issue. Many who suffer from chronic back pain opt for spine surgery. Spine surgery provides hopes of relieving some of the symptoms. Yes, it can alleviate some of the symptoms, but never all of your pain.

Fact-Finding research published in the Ohio State Workers’ compensation database found spinal fusion (spine surgery) failed to provide lasting relief for 75% of the operated patients. In addition, at 2-years post-surgery (after surgery), some 40% of patients still relied on painkillers to alleviate the pain. So, take our advice and opt for our conservative treatment before you even consider spine surgery.

How Common Is A Slip-Disc At L2-L3 Spinal Motion Segment?

Slip-disc at L2-L3 level is less common than those at L3-L4, L4-L5, and L5-S1, but when it is present, it may have a misleading clinical picture that doesn’t fit into any of the categories. In addition, if the slip-disc at L2/L3 level is very severe, it may also compress the L4, L5, and S1 (first sacral segment or tailbone).

Compression of the L4, L5, and S1 nerve may result in low back pain, buttock pain, thigh pain, leg pain, sensory changes that affect the lower limbs, and weaknesses in the lower leg. However, the presenting symptoms may not follow any of the dermatomal or myotomal distribution patterns. In addition, the deep tendon reflex may be hypersensitive or less reactive, which may be misleading when a healthcare practitioner concludes the differential diagnosis.

The femoral nerve stretch test may be positive when a patient presents with slip-disc at the L2-L3 level. The primary nerve innervation for the femoral nerve comes from L2, L3, and L4. Slip-disc at the L2-L3 level should be able to reproduce the pain, numbness, or tingling sensation at the front and outer side of the thigh or in the inguinal region. Weakness or atrophy of the quadriceps muscles or tibialis anterior may be present too. MRI of the lumbar spine can show the severity of the slip-disc and the segments involved. It can also reveal if there is any compression of the nerve roots.

What Should You Do If You Suspect A Slip-Disc?

If you suspect a herniated disc in the lumbar (slipped disc or slip-disc), visit a CSC center today for holistic, non-invasive treatments! Chiropractic Specialty Center® has the best non-surgical & non-invasive clinical teams for accurate diagnosis and holistic treatment of slip-discs.

Our care methods are superior to others, as we targeted every aspect of a spinal disc issue. In short, the procedures you get from us will lead to faster and longer-lasting improvements. In addition, in our center, only the best clinical physiotherapists and expert chiropractors in KL will render care simultaneously through advanced technology that others do not have in Malaysia.

NSD Therapy® is the best and most sophisticated non-surgical treatment for slip-disc. NSD Therapy is the most holistic method of spinal decompression therapy. It incorporates the best clinical practices of physiotherapy, chiropractic, and rehabilitation. Best of all, the care you receive is painless. Please don’t settle for less; our proven therapy methods for the L2-L3 slip-disc or a slipped disc at any other level of the spine are unmatched.

Contact us now for holistic L2-L3 treatment of disc bulge, nerve pain & slip disc through advanced methods of NSD Therapy® for Lasting relief today!

Classification of the level and severity of spinal cord injury

Medical rehabilitation

Until the early 1990s, there was no single generally accepted classification of the level and severity of spinal cord injury. Doctors often used different definitions of the level of injury, complete and incomplete injuries. This article provides a classification developed by the American Spinal Injury Association (ASIA).

The spinal cord is located inside the spinal canal. Segmental levels of the spinal cord are determined by the anterior and posterior spinal roots, which connect to the spinal nerves near the intervertebral foramina. There are 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1-3 coccygeal segments of the spinal cord (Figure 1) . The upper cervical segments are located at the level of the bodies of the cervical vertebrae corresponding to their serial number. The lower cervical and upper thoracic segments are one vertebra higher than the corresponding vertebral bodies. In the middle thoracic region, this difference is equal to two vertebrae, in the lower thoracic region, to three vertebrae. The lumbar segments are located at the level of the bodies of the tenth and eleventh thoracic vertebrae, the sacral and coccygeal segments correspond to the levels of the twelfth thoracic and first lumbar vertebrae. The lower border of the spinal cord tapering in the form of a cone is located at the level of the second lumbar vertebra. Below this level is the terminal filament, which is the remnant of the final section of the embryonic spinal cord and is surrounded by the roots of the spinal nerves and the membranes of the spinal cord. The roots of the spinal nerves at this level form the so-called cauda equina.

Figure 1. Spine and segmentation of the spinal cord

Sensory and motor levels

A dermatome is a skin area innervated by a certain segment of the spinal cord. Figures 2 and 3 show dermatomes and key points for their definition, as well as muscle groups recommended for testing by the American Spinal Injury Association. After injury, dermatomes may expand or contract due to spinal cord plasticity. The complete form that ASIA recommends filling out when examining a patient with a spinal cord injury is available in English in pdf format (Adobe Acrobat Reader required to view).

Figure 2. Areas of sensitive innervation

C2-C4. C2 dermatome includes the skin of the occiput and upper neck. C3 – lower neck and collarbone. C4 – subclavian region.
C5-T1. These dermatomes are located on the arms. C5 – outer surface of the arm at and above the elbow. C6 – radial (from the side of the thumb) part of the forearm and hand. C7 – middle finger, C8 – lateral part of the hand, T1 – inner side of the forearm.
T2-T12. Thoracic dermatomes are located in the axillary and thoracic region. T3-T12 cover chest and back to hips. The nipples are located in the middle of T4. T10 is located near the navel. T12 ends just above the thigh.
L1-L5. Dermatomes located in the area of ​​the hip joints and groin are innervated by the L1 segment of the spinal cord. L2 and L3 cover the front of the thighs and knees. L4 and L5 – medial (inner) and lateral (outer) parts of the legs.
S1-S5. S1 is located on the heel and calf. S2 – back of the thighs and popliteal fossa. S3 – medial buttocks and S4-S5 – perineum. S5 – anal area.

Figure 3. Key muscle groups

Ten muscle groups reflect the motor innervation of the cervical and lumbosacral sections of the spinal cord. The ASIA system does not test the abdominal muscles (i.e., T2-11), since at the thoracic level it is much easier to locate the affected segment of the spinal cord along the corresponding dermatome. Some other muscles (such as the popliteal) are also excluded, since the segments that innervate them are already represented by other muscles.
Muscles of the hand. C5 innervates the flexors of the forearm (biceps), C6 the extensors of the wrist, C7 the extensors of the forearm (triceps), C8 the flexors of the fingers, and T1 the abductor (adductor) of the little finger.
Leg muscles. Innervated by the lumbar segments of the spinal cord. L2 innervates the hip flexors (m. psoas), L3 – knee extensors (m. quadriceps), L4 – dorsal foot flexors (m. tibialis anterior), L5 – thumb extensors (m. extensor hallucis longus), S1 – plantar flexors of the foot (m. gastrocnemius).
The anal sphincter is innervated by S4-S5. It is very important in the neurological examination of patients with spinal cord injury. If voluntary contraction of the anal sphincter is possible, the spinal cord injury is considered incomplete, regardless of any other evidence. It is important to note that testing certain muscle groups according to the ASIA classification simplifies the real situation, since almost every muscle receives innervation from two or more segments of the spinal cord.

Levels of spinal cord injury

Doctors use two different definitions of the level of spinal cord injury. Based on the same neurological examination, neuropathologists and rehabilitation specialists can determine a different level of injury. Neuropathologists usually determine the level of damage by the first segment of the spinal cord in which dysfunction is detected. At the same time, physical therapy and rehabilitation doctors determine the level of damage in the lowest segment with preserved function. Thus, if a patient has normal sensitivity at the C3 level and none with C4, the rehabilitator will say that the sensory level is C3, and the neuropathologist or neurosurgeon will call the damage level C4. Most traumatologists and orthopedists determine the level of damage by the level of damage to the spine.
ASIA recommends determining the level of damage by the lowest segment with preserved function.

Complete or partial damage

In the clinic, spinal cord injury is usually described as complete or incomplete. A complete injury is one in which there is no motor or sensory function below the site of injury. However, this definition is not always applicable. The following three examples illustrate the shortcomings and ambiguities of the traditional definition. The ASIA committee considered these issues when developing the spinal cord injury classification in 1992 year.

• Partially protected zones. Often, some segments of the spinal cord below the injury site retain a partial function, although in the other underlying segments, both motor and sensory function are absent. This is a fairly common occurrence. Many patients have areas of partial preservation. What kind of damage in this case – complete or incomplete, and at what level?
• Lateral preservation. A function may be partially retained on one side, but not present on the other, or be there on another level. For example, if a patient has no sensitivity with C4 on the right and with T1 on the left, is this damage complete or incomplete, and at what level?
• Restore function. An initially missing function below the fault can then be restored. Does this mean that the spinal cord injury was complete and became incomplete? This is not a trivial matter, because if, for example, a clinical trial is being conducted in which only patients with complete spinal cord injury participate, it is necessary to stipulate the timing of the assessment of the status.

Most clinicians consider damage complete if there is a level of the spinal cord below which no function is detected. The Committee of the American Spinal Injury Association decided to take this criterion to its logical limit: the injury is considered complete if there is no motor and sensory function in the anal and perineal regions, which are innervated by the sacral (S4-S5) spinal cord.
The decision to make the absence of function at the S4-S5 level the criterion for complete damage not only removed the issue of zones of partial and lateral function preservation, but also solved the problem of restoration of function. As it turned out, only in a small number of patients in whom neurological functions at the level of S4-S5 were absent, they are restored spontaneously. The ASIA classification separately indicates the motor and sensory levels on each side and the zones of partial preservation, as this simplifies the criterion for assessing the completeness of the damage.
Finally, the question itself: complete damage or incomplete, can be debatable. The absence of motor and sensory function below the injury site does not necessarily mean the absence of axons that cross the injury site. Animal studies and clinical data indicate that the function that is absent below the site of injury can be restored to some extent by restoring the blood supply to the spinal cord (in the case of arteriovenous malformation caused by ischemia), decompression (if there is chronic compression – compression of the spinal cord) or drug therapy, for example, 4-aminopyridine. Assessing spinal cord injury as complete, one should not deprive a person of hope for recovery.

Severity classification of spinal cord injury

Physicians have long used the clinical neurological deficit score, developed at Stokes Manville before World War II and introduced by Frankel in the 1970s. On this scale, patients were divided into five categories: no function (A), only sensory function (B), some sensory and motor function preserved (C), useful motor function (D), and normal (E).

ASIA Injury Severity Scale

A=Complete: No motor or sensory function in the sacral segments S4-S5
B=Incomplete: Sensation preserved but no motor function in segments below the neurological level, including S4-S5.
C=Incomplete: Motor function below the neurological level is preserved, but more than half of the key muscles are below
neurological level have a strength of less than 3 points.
D=Incomplete: Below neurological level of motor function is preserved, and at least half of the key muscles below the neurological level have a strength of 3 points or more.
E=Normal: motor and sensory functions are normal.

Clinical syndromes

Central
Brown-Sekara
Front pillars
Brain cone
Horse tail

The ASIA Spinal Cord Injury Severity Scale is based on the Frankel scale, but differs from it in a number of important ways.
First, the absence of any function below the level of damage was replaced in category A with the absence of motor and sensory function in the sacral segments S4-S5. This definition is clear and unambiguous.
Category B ASIA is essentially identical to Frankel B, but adds a requirement for retained sensory function in S4-S5. It should be noted that the defining moment in categories A and B on the ASIA scale is the preservation of motor and sensory function in S4-S5.
ASIA also added a quantitative measure for categories C and D. The Frankel scale required clinicians to rate the functional fitness of the lower extremities. This not only introduced a subjective element into the classification, but also ignored the assessment of hand function in patients with cervical spinal cord injury. To circumvent this problem, ASIA specifies that category C includes patients with more than half of the key (recommended for testing) muscles retaining strength less than 3 points. Otherwise, the patient is assigned to category D.
Category E is interesting in that it includes patients with spinal cord injury without any neurological deficit, at least detectable on neurological examination. The ASIA Motor and Sensory Scale does not take into account the presence of spasticity, pain, muscle weakness, and some forms of dysesthesia that may result from spinal cord injury. Such patients should be assigned to category E.
ASIA has also classified incomplete spinal cord injury into five types.
Central syndrome (with greater damage to the gray matter of the spinal cord – hemorrhages, necrosis): unequal severity of motor disorders in the upper and lower extremities, a varied degree of sensitivity impairment.
Brown-Sequard syndrome – damage to one half of the spinal cord: impaired motor functions and proprioceptive sensitivity on the side of the lesion and loss of pain and temperature sensitivity on the other side.
Syndrome of the anterior pillars: impaired motor functions of both pain and temperature sensitivity while maintaining proprioceptive sensitivity (damage affects the lateral corticospinal and corticothalamic tracts, the posterior columns remain intact).
Syndromes of the conus medullary and cauda equina are observed when there is damage in the region of the cone of the spinal cord and cauda equina. In this case, the spinal nerves are injured, which is manifested by flaccid paralysis of the lower extremities, anesthesia of the sciatic zone, impaired bowel and bladder functions.

Conclusion

There is no unity in terminology related to the level and severity of spinal cord injury. The American Spinal Injury Association has attempted to standardize the terms used to describe spinal cord injury. The new ASIA classification is now accepted by almost all organizations dealing with this problem worldwide.

Treatment of protrusion of the lumbar spine in Moscow at the Dikul clinic: prices, appointments

Treatment of protrusions of the lumbar spine in Moscow at the Dikul clinic: prices, appointments | Center Dikul

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• Intervertebral disc protrusion treatment
• Lumbar spine protrusion treatment

Back pain can come from the intervertebral disc, nerves, muscles, bones and facet joints. A bulging disc is the most common cause of lower back and leg pain in all age groups. A small disc protrusion is often asymptomatic. At the same time, a large protrusion of the disc can protrude into both the foramen and the spinal canal and lead to the impact on the nerve structures with the development of radicular syndrome or spinal canal stenosis with the development of such a serious condition as Cauda equine.

Most back pain caused by a small disc protrusion resolves on its own.

Small disc protrusions are often poorly visualized on both radiography and MRI.

Chronic back pain caused by a bulging disc after injury has a major impact on work performance. Treatment of protrusion of the lumbar spine is usually conservative, but in the presence of compression of the nerve structures, surgical treatment may be recommended.

Causes

Aging and wear are usually the main causes of disc protrusion. However, many additional factors can stimulate or accelerate this degenerative spinal condition, including:

• Sudden injuries such as those that may occur during sports, a car accident, or a severe fall
• Genetic predisposition to degenerative disc disease (osteochondrosis)
• Congenital malformations of the spine
• Obesity or weight bearing
• Lack of adequate and regular physical activity
• Malnutrition
• Smoking
• Impact of the person’s position or repetitive pressure on the discs of the lumbar spine
• As shown in the diagram above, the least pressure on the discs in the lumbar spine occurs in the supine position, while the greatest pressure on the discs occurs in the sitting position, with the torso leaning with the weight, with the center of gravity shifted forward along the center line.
• It is important to note that while sitting, the impact on the lumbar discs is greater than when standing.
• Another cause of a bulging disc in the lumbar region is excessive force when the vertebrae slide excessively, usually from overstretching or from lifting heavy objects with improper technique.

The muscles of the back try to prevent the spine from bending forward and causing compression, but the applied force vector for them is significant, and therefore the vertebrae slide too much in relation to each other.

Force vectors acting on the lumbar spine during sitting

Symptoms

General symptoms

• Insomnia – secondary to pain
• Weight loss secondary to chronic pain and loss of appetite. Loss of appetite observed in patients suffering from back pain due to spinal stenosis or cancer

Back pain

• Discogenic pain. Lumbar discogenic pain is felt in the region of the lumbar dermatome L1-L5.

Lumbar radicular pain

• The nature of the pain is sharp and shooting pain.
• Pain is provoked by certain movements (for example, bending or twisting the torso, coughing and sneezing).
• Time and intensity of pain – pain worse at night
• Pain radiates to the lower extremity – along the dermatome of the nerve roots L1, L2, L3, L4, L5 or S1.
• Dermatomal pain caused by root compression

Compression of the L1 root – pain spreads to the area of ​​the inguinal dermatome.

L2 root compression – Pain is felt along the anterior and lateral surface of the mid-thigh, mid-thigh and lateral thigh.

L3 root compression – Pain is felt along the inner and anterior-lower part of the thigh.

L4 root compression P- The pain is localized in the lower leg, mainly on the front and back side.

L5 P Compression – Pain is felt on the front lateral side of the lower leg and dorsal part of the foot in the region of the middle three toes.

S1 root compression – Pain is felt on the lateral side of the feet.

Compression S2 – Pain is felt in the back of the thigh and back of the upper 2/3 of the leg.

Tingling extending along the dermatome of nerve roots L1-S2

Numbness extending along the dermatome of nerve roots L1-S2

Other symptoms of disc protrusion

Paravertebral muscle spasm

• Pair vertebral muscle spasm is observed between the vertebrae L1 and L5.
• Muscle spasm is often permanent and causes severe pain secondary to muscle fatigue and accumulation of lactic acid in the muscles.

Muscle weakness in the lower limb

• Motor nerve ischemia. Strong pressure within the foraminal intervertebral foramen causes ischemic changes in the motor nerve, resulting in weakness in the leg.
• Movements in the spine. Flexion, extension, abduction, and extension of the lower limb become weak, depending on the level of root involvement in the lumbar spine.
• Change of position. The patient has difficulty getting in and out of a sitting or lying position.
• Motor disorders at the level of root damage

L1 – causes hip flexion weakness.

L2 – causes hip flexion weakness.

L3 – causes weakness of hip flexion and knee extension.

L4 – Impossibility of extension at the knee and dorsiflexion at the ankle.

L5 – Unable to perform big toe extension, plantar extension, inability to lift the big toe up.

S1 – Causes weakness in knee extension.

Reduced knee and ankle reflexes

• Patella reflex – L2 and L3. Damage to the root causes an abnormal reflex of the knee joint.
• Achilles reflex – reduced or absent with damage to the nerve roots L4-5 and S1.

Muscle atrophy

• Decrease in muscle mass observed on the side of the protrusion of the disc
• Muscle atrophy or thinning of the leg is associated with weakness in the leg.

Since the symptoms of lumbar protrusion are similar to many other more serious conditions, it is important to make a full diagnosis before starting treatment.

Diagnostics

Lumbar protrusion treatment

Medication

• OTC analgesics – Designed for mild to moderate pain.
• Anti-inflammatory drugs – Designed to reduce nerve root inflammation caused by irritation and pinching (aspirin, ibuprofen (Motrin, Advil) and naproxen (Aleve).

Prescription analgesics

• Tramal – prescribed for persistent pain.
• Opiates are recommended when other drugs fail to relieve pain.
• Opioids are useful in the treatment of chronic intense pain.

Muscle relaxants

Antidepressants

• Effective as an analgesic in the treatment of chronic neuropathic pain.
• Used as an analgesic when other pain medications (NSAIDs, tramadol or opioids) cause significant side effects.
• For neuropathic pain associated with depression – used as an analgesic and antidepressant.
• Most commonly prescribed antidepressants
• Duloxetine
• Milnacipran
• Tricyclic antidepressants (Elavil)

Sedatives

• Sedatives (such as benzodiazepines) are prescribed to reduce anxiety caused by pain. In addition, they can to some extent reduce muscle spasm and normalize sleep.

Antiepileptic drugs

• The analgesic action of these drugs is used in the treatment of chronic neuropathic pain.
• Indicated as an analgesic if NSAIDs, tramadol or opioids are associated with severe side effects.

Most commonly prescribed antiepileptics for pain:

• Gabapentin (Neurontin).
• Pregabalin (Lyrica).

Interventional pain management

• Translaminar epidural corticosteroid injection. An epidural injection of corticosteroids helps reduce disc and nerve root inflammation.
• Caudal Corticosteroid Injection – Caudal epidural injection is an alternative method of delivering corticosteroids into the epidural space.
• Trans-foraminal epidural injection – targeted injection of cortisone into the area of ​​root compression due to disc protrusion.

Chiropractic

This treatment is effective for the treatment of protruding discs of small to medium size.

Manual therapy often avoids invasive treatments such as interventional pain therapy and surgery.

• Osteopathic manual therapy is often used in the treatment of lumbar disc protrusion and can be effective within the first month after the onset of symptoms.
• Massage . The use of therapeutic massage helps to relieve pain in the superficial and deep layers of muscles and connective tissue. Massage helps to improve the blood supply to the muscles, as well as reduce muscle spasm.
• LFK
• Stretching and flexibility exercises help to restore the mobility of the motor segments of the lumbar spine. Weight training is essential for strengthening muscles and strengthening spinal stability.
• Physiotherapy (cryotherapy, ultrasound, electrical stimulation, magnetotherapy, TENS (Transcutaneous Electrical Nerve Stimulation). These and other physiotherapy methods are widely used in the treatment of lumbar disc protrusion.
• Acupuncture. The method of treatment is useful if necessary to reduce pain and restore conduction along the nerve fibers.

Surgical treatment

Surgical nerve decompression. These operations are performed to relieve pressure on the nerves:

• Microdiscectomy – Microscopic surgery leads to a quick recovery.
• Percutaneous nucleoplasty . Minimally invasive surgical treatment ensures rapid recovery
• Discectomy – after skin incision and surgical exposure, the disc is removed.
• Laminectomy – the bony part of the vertebra (lamina) is removed to widen the bone tunnel
• Fusion operation – this surgical treatment is used after unsuccessful operations to decompress the nerves.