What are dermatomes and how do they relate to spinal nerves. How many dermatomes are there in the human body. Which areas of skin do different dermatomes innervate. Why are dermatomes clinically important for diagnosing neurological conditions.

The Basics of Dermatomes and Spinal Nerves

A dermatome refers to an area of skin that receives sensory innervation from a single spinal nerve. The human body contains 31 pairs of spinal nerves that branch off from the spinal cord, forming nerve roots. These spinal nerves play a crucial role in relaying sensory, motor, and autonomic information between the body’s peripheral regions and the central nervous system (CNS).

While there are 31 pairs of spinal nerves, the body has only 30 dermatomes. This discrepancy arises because the C1 spinal nerve typically lacks a sensory root. Consequently, dermatomes begin with the C2 spinal nerve.

How many spinal nerve groups are there?

The spinal nerves are organized into five distinct groups based on their origin in the spine:

• Cervical nerves (C1-C8): 8 pairs originating from the neck
• Thoracic nerves (T1-T12): 12 pairs originating from the torso
• Lumbar nerves (L1-L5): 5 pairs originating from the lower back
• Sacral nerves (S1-S5): 5 pairs associated with the sacrum in the pelvis
• Coccygeal nerves: 1 pair originating from the coccyx (tailbone)

Dermatome Distribution and Patterns

Dermatomes exhibit a segmented distribution throughout the body. It’s important to note that the precise dermatome pattern can vary between individuals, and some overlap may occur between neighboring dermatomes.

The distribution of dermatomes differs between the torso and limbs. In the torso and core, dermatomes are arranged horizontally, appearing like stacked discs when viewed on a body map. This horizontal arrangement is due to the lateral exit of spinal nerves from the spine.

In contrast, dermatomes in the limbs follow a different pattern. Due to the elongated shape of the limbs, these dermatomes generally run vertically along the limb’s long axis, such as down the leg.

How are dermatomes numbered?

Dermatomes are numbered based on their corresponding spinal nerve. For instance, the C3 dermatome is associated with the C3 spinal nerve. This numbering system allows for easy identification and mapping of sensory innervation patterns.

Cervical Dermatomes and Their Innervation Areas

The cervical dermatomes are associated with the upper body, including the head, neck, and arms. Here’s a breakdown of the cervical dermatomes and their general areas of innervation:

• C2: Lower jaw, back of the head
• C3: Upper neck, back of the head
• C4: Lower neck, upper shoulders
• C5: Area of the collarbones, upper shoulders
• C6: Shoulders, outside of arm, thumb
• C7: Upper back, back of arm, pointer and middle finger
• C8: Upper back, inside of arm, ring and little finger

Which cervical dermatome is responsible for sensation in the thumb?

The C6 dermatome is primarily responsible for sensation in the thumb. This dermatome also covers the shoulders and the outside of the arm.

Thoracic Dermatomes and Their Coverage

Thoracic dermatomes are associated with the chest, upper back, and abdomen. Here’s an overview of the thoracic dermatomes and their general areas of innervation:

• T1: Upper chest and back, armpit, front of arm
• T2-T4: Upper chest and back
• T5-T7: Mid-chest and back
• T8-T9: Upper abdomen and mid-back
• T10: Abdomen (area of belly button) and mid-back
• T11-T12: Lower abdomen and mid-back

Which thoracic dermatome is associated with the belly button area?

The T10 dermatome is typically associated with the area around the belly button (navel). This dermatome also covers the corresponding area on the mid-back.

Lumbar Dermatomes and Their Innervation Patterns

Lumbar dermatomes are primarily associated with the lower back, hips, and legs. Here’s a breakdown of the lumbar dermatomes and their general areas of innervation:

• L1: Lower back, hips, groin
• L2-L3: Lower back, front and inside of thigh
• L4: Lower back, front of thigh and calf, area of knee, inside of ankle
• L5: Lower back, front and outside of calf, top and bottom of foot, first four toes

Which lumbar dermatome is responsible for sensation in the big toe?

The L5 dermatome is primarily responsible for sensation in the big toe, as well as the other toes except for the little toe. This dermatome also covers the top and bottom of the foot, the front and outside of the calf, and part of the lower back.

Sacral and Coccygeal Dermatomes

The sacral and coccygeal dermatomes are associated with the lower body, including the buttocks, genitals, and parts of the legs. Here’s an overview of these dermatomes and their general areas of innervation:

• S1: Lower back, back of thigh, back and inside of calf, little toe
• S2-S3: Buttocks, genitals, back of thigh and calf
• S4-S5: Buttocks
• Coccygeal: Buttocks, area of tailbone

Which sacral dermatome is associated with the little toe?

The S1 dermatome is responsible for sensation in the little toe. This dermatome also covers areas of the lower back, the back of the thigh, and the back and inside of the calf.

Clinical Importance of Dermatomes

Dermatomes play a crucial role in clinical practice, particularly in the assessment and diagnosis of various neurological conditions. Understanding dermatome patterns can help healthcare professionals pinpoint the source of certain symptoms and identify potential nerve root problems.

How do dermatomes aid in diagnosing neurological conditions?

Dermatomes are particularly useful in diagnosing conditions that affect specific nerve roots. When symptoms such as pain, numbness, or tingling occur along a specific dermatome, it can indicate a problem with the corresponding nerve root in the spine. This information helps clinicians narrow down the potential source of the issue and guide further diagnostic tests or treatments.

One common condition where dermatome knowledge is invaluable is radiculopathy. This refers to a group of conditions where a nerve root in the spine is compressed or pinched. Symptoms of radiculopathy often follow one or more dermatome patterns, helping clinicians identify which specific nerve root is affected.

What are some examples of conditions where dermatome knowledge is useful?

Dermatome knowledge is particularly useful in diagnosing and treating several conditions, including:

1. Herniated discs: When a spinal disc herniates and compresses a nerve root, symptoms often follow the corresponding dermatome.
2. Spinal stenosis: This condition can cause compression of multiple nerve roots, leading to symptoms in multiple dermatomes.
3. Shingles (Herpes Zoster): This viral infection often affects specific dermatomes, causing a characteristic rash and pain pattern.
4. Diabetic neuropathy: Understanding dermatomes can help in assessing the progression and distribution of nerve damage in diabetic patients.
5. Spinal cord injuries: Dermatome mapping can assist in determining the level and extent of spinal cord injuries.

By utilizing dermatome knowledge, healthcare professionals can more accurately diagnose these conditions, track their progression, and develop targeted treatment plans.

Variations and Limitations in Dermatome Mapping

While dermatome diagrams provide a valuable guide for understanding sensory innervation patterns, it’s important to recognize that some variations and limitations exist in their application.

Do dermatome patterns vary between individuals?

Yes, dermatome patterns can vary to some extent between individuals. While the general distribution remains consistent, the exact boundaries of each dermatome may differ slightly from person to person. This individual variation is one reason why clinicians often use dermatome maps as a general guide rather than an absolute reference.

Additionally, there can be some overlap between adjacent dermatomes. This overlap means that a small area of skin might receive sensory innervation from more than one spinal nerve. This redundancy in sensory innervation can sometimes complicate the interpretation of symptoms in clinical settings.

What are some limitations of using dermatome maps in clinical practice?

While dermatome maps are incredibly useful, they do have some limitations that clinicians need to be aware of:

• Individual variations: As mentioned, the exact boundaries of dermatomes can vary between people.
• Overlap between dermatomes: Adjacent dermatomes may have areas of overlap, which can sometimes lead to ambiguous symptom patterns.
• Complexity of the nervous system: The nervous system is intricate, and symptoms don’t always follow clear-cut dermatome patterns.
• Other factors affecting sensation: Various factors, such as referred pain or central sensitization, can complicate the interpretation of sensory symptoms.
• Limited applicability to motor function: While dermatomes are useful for mapping sensory function, they don’t directly correspond to motor function, which follows a different pattern (myotomes).

Despite these limitations, dermatome maps remain an invaluable tool in neurological assessment and diagnosis when used in conjunction with other clinical information and diagnostic techniques.

Dermatomes Diagram: Spinal Nerves and Locations

A dermatome is an area of skin supplied by a single spinal nerve. There are 31 pairs of spinal nerves, forming nerve roots that branch from your spinal cord.

Your spinal nerves help to relay sensory, motor, and autonomic information between the rest of your body and your central nervous system (CNS).

So why are dermatomes important? How many are there? And where can they be found? Continue reading as we answer these questions and more.

Each of your dermatomes is supplied by a single spinal nerve. Let’s take a closer look at both of these components of the body.

Your spinal nerves

Spinal nerves are part of your peripheral nervous system (PNS). Your PNS works to connect the rest of your body with your CNS, which is made up of your brain and spinal cord.

You have 31 pairs of spinal nerves. They form nerve roots that branch from your spinal cord. Spinal nerves are named and grouped by the region of the spine that they’re associated with.

The five groups of spinal nerves are:

• Cervical nerves. There are eight pairs of these cervical nerves, numbered C1 through C8. They originate from your neck.
• Thoracic nerves. You have 12 pairs of thoracic nerves that are numbered T1 through T12. They originate in the part of your spine that makes up your torso.
• Lumbar nerves. There are five pairs of lumbar spinal nerves, designated L1 through L5. They come from the part of your spine that makes up your lower back.
• Sacral nerves. Like the lumbar spinal nerves, you also have five pairs of sacral spinal nerves. They’re associated with your sacrum, which is one of the bones found in your pelvis.
• Coccygeal nerves. You only have a single pair of coccygeal spinal nerves. This pair of nerves originates from the area of your coccyx, or tailbone.

Your dermatomes

Each of your dermatomes is associated with a single spinal nerve. These nerves transmit sensations, such as pain, from a specific area of your skin to your CNS.

Your body has 30 dermatomes. You may have noticed that this is one less than the number of spinal nerves. This is because the C1 spinal nerve typically doesn’t have a sensory root. As a result, dermatomes begin with spinal nerve C2.

Dermatomes have a segmented distribution throughout your body. The exact dermatome pattern can actually vary from person to person. Some overlap between neighboring dermatomes may also occur.

Because your spinal nerves exit your spine laterally, dermatomes associated with your torso and core are distributed horizontally. When viewed on a body map, they appear very much like stacked discs.

The dermatome pattern in the limbs is slightly different. This is due to the shape of the limbs as compared with the rest of the body. In general, dermatomes associated with your limbs run vertically along the long axis of the limbs, such as down your leg.

Your dermatomes are numbered based on which spinal nerve they correspond to. Below, we’ll outline each dermatome and the area of the body that it’s associated with.

Remember that the exact area that a dermatome may cover can vary by individual. Some overlap is also possible. As such, consider the outline below to be a general guide.

Cervical spinal nerves

• C2: lower jaw, back of the head
• C3: upper neck, back of the head
• C4: lower neck, upper shoulders
• C5: area of the collarbones, upper shoulders
• C6: shoulders, outside of arm, thumb
• C7: upper back, back of arm, pointer and middle finger
• C8: upper back, inside of arm, ring and little finger

Thoracic spinal nerves

• T1: upper chest and back, armpit, front of arm
• T2: upper chest and back
• T3: upper chest and back
• T4: upper chest (area of nipples) and back
• T5: mid-chest and back
• T6: mid-chest and back
• T7: mid-chest and back
• T8: upper abdomen and mid-back
• T9: upper abdomen and mid-back
• T10: abdomen (area of belly button) and mid-back
• T11: abdomen and mid-back
• T12: lower abdomen and mid-back

Lumbar spinal nerves

• L1: lower back, hips, groin
• L2: lower back, front and inside of thigh
• L3: lower back, front and inside of thigh
• L4: lower back, front of thigh and calf, area of knee, inside of ankle
• L5: lower back, front and outside of calf, top and bottom of foot, first four toes

Sacral spinal nerves

• S1: lower back, back of thigh, back and inside of calf, last toe
• S2: buttocks, genitals, back of thigh and calf
• S3: buttocks, genitals
• S4: buttocks
• S5: buttocks

Coccygeal spinal nerves

buttocks, area of tailbone

Dermatomes are important because they can help to assess and diagnose a variety of conditions. For instance, symptoms that occur along a specific dermatome may indicate a problem with a specific nerve root in the spine.

Examples of this include:

• Radiculopathies. This refers to conditions in which a nerve root in the spine is compressed or pinched. Symptoms can include pain, weakness, and tingling sensations. Pain from radiculopathies can follow one or more dermatomes. One form of a radiculopathy is sciatica.
• Shingles. Shingles is a reactivation of the varicella zoster (chickenpox) virus that lies dormant in the nerve roots of your body. Symptoms of shingles, such as pain and a rash, occur along dermatomes associated with the affected nerve root.

Dermatomes are areas of skin that are connected to a single spinal nerve. You have 31 spinal nerves and 30 dermatomes. The exact area that each dermatome covers can be different from person to person.

Spinal nerves help to relay information from other parts of your body to your central nervous system. As such, each dermatome transmits sensory details from a particular area of skin back to your brain.

Dermatomes can be helpful in evaluating and diagnosing conditions affecting the spine or nerve roots. Experiencing symptoms along a specific dermatome can help inform doctors about which area of the spine may be affected.

Lumbar Spinal Nerves | Spine-health

Two spinal nerves branch off from the right and left sides of the spinal cord or the cauda equina at each spinal segment. These spinal nerves are formed by 2 types of fibers—sensory fibers that send messages to the brain (feeling pain when the leg is hurt) and motor fibers that receive messages from the brain (lifting the leg to get out of a car).

Learn how the lumbar spinal discs function and how lower back conditions can cause back pain and/or radiating pain. Watch Now

There are 5 pairs of lumbar spinal nerves that progressively increase in size from L1 to L5. These nerves exit the intervertebral foramina below the corresponding vertebra. For example, the L4 nerve exits beneath the L4 vertebra through the L4-L5 foramen. These nerves course down from the lower back and merge with other nerves to form the lumbar and lumbosacral plexuses (a network of nerves), which innervate the lower limbs.

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Nerve Root and Spinal Nerve

The structure of a spinal nerve as it leaves the spinal cord or cauda equina includes:

• Nerve root: Part of the nerve that branches off the spinal cord or cauda equina. At each level, a pair of nerve roots emerge from the right and left sides of the spinal cord. Each pair consists of a dorsal root at the back and a ventral root in the front.
• Spinal nerve: A single nerve formed when the dorsal and ventral nerve roots merge, typically inside the intervertebral foramen (bony opening in between adjacent vertebrae). The spinal nerve travels a short distance inside the intervertebral foramen, after which it branches off into several nerves that innervate different parts of the body.

Doctors may sometimes refer to the part of the spinal nerve exiting the intervertebral foramen as the nerve root or use the terms nerve root and spinal nerve interchangeably.

In This Article:

• Lumbar Spine Anatomy and Pain

• Lumbar Vertebrae

• Lumbar Discs

• Lumbar Spinal Nerves

• Soft Tissues of the Lumbar Spine

• Spinal Cord and Cauda Equina of the Lumbar Spine

• Causes of Pain in the Lumbar Spine

• Lumbar Spine Anatomy Video

Dermatomes and Myotomes

The spinal nerves innervate the skin and the muscles of a specific region.

• A dermatome is a specific area of skin that is supplied by the dorsal root fibers of a spinal nerve. The dorsal root fibers carry sensory information from the dermatome to the brain.
• A myotome is a group of muscles controlled by the ventral root fibers of a spinal nerve. The ventral root fibers carry motor signals from the brain to the myotome.

When a spinal nerve gets irritated or compressed, sensory and/or motor deficits may occur in the corresponding dermatome and myotome.

Functions of the Lumbar Spinal Nerves

The 5 pairs of lumbar spinal nerves innervate the lower limbs. While innervation can vary among individuals, some common patterns include

²
Dulebohn SC, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2019 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441822/
:

• L1 spinal nerve provides sensation to the groin and genital regions and may contribute to the movement of the hip muscles.
• L2, L3, and L4 spinal nerves provide sensation to the front part of the thigh and inner side of the lower leg. These nerves also control movements of the hip and knee muscles.
• L5 spinal nerve provides sensation to the outer side of the lower leg, the upper part of the foot, and the web-space between the first and second toe. The L5 spinal nerve controls hip, knee, foot, and toe movements.

Read more about Spinal Cord and Spinal Nerve Roots

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The L4 and L5 nerves (along with other sacral nerves) contribute to the formation of the large sciatic nerve that runs down from the rear pelvis into the back of the leg and terminates in the foot. Symptoms and signs arising from these nerves, typically referred to as sciatica, can cause a sharp, burning pain radiating down the leg with associated weakness and numbness.

See Sciatic Nerve and Sciatica

While the lumbar spinal nerves progressively increase in size, the openings for these nerves (intervertebral foramina) decrease in size from L1 to L5.

¹
Waxenbaum JA, Futterman B. Anatomy, Back, Lumbar Vertebrae. [Updated 2018 Dec 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459278/
This anatomy, in addition to lower back disorders, such as disc herniation or degeneration may cause the nerve to get compressed, resulting in leg pain and weakness.

See Causes of Lower Back Pain

Dr. Kara Beasley is a neurosurgeon practicing at Boulder Neurosurgical & Spine Associates, where she has several years of experience specializing in spine and brain surgery.

• 1
  Waxenbaum JA, Futterman B. Anatomy, Back, Lumbar Vertebrae. [Updated 2018 Dec 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459278/
• 2
  Dulebohn SC, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2019 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441822/

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Radicular syndrome of the sacro-lumbar spine: symptoms and treatment

Articles

Reading time 10 min

Radicular or radicular syndrome

This is a complex of clinical manifestations caused by compression of the roots of the spinal cord new nerves. Sometimes the radicular syndrome is called radiculitis, but with this disease there is often no inflammatory process, so it is correct – radiculopathy.

Radicular syndrome or radiculopathy is a complex of symptoms that develops in the pathology of the roots of the spinal cord. Radiculopathy means compression of the root, the appearance of a protective spasm of the muscles, a violation of the blood supply to the affected area and the appearance of pain.

Krasnodar
Neurologist

• Khetsia R.Z. , Ph.D.

• This is a complex of clinical manifestations caused by compression of the spinal nerve roots. Sometimes the radicular syndrome is called radiculitis, but with this disease there is often no inflammatory process, so it is correct – radiculopathy.

  Radicular syndrome or radiculopathy is a complex of symptoms that develops in the pathology of the roots of the spinal cord. Radiculopathy means compression of the root, the appearance of a protective spasm of the muscles, a violation of the blood supply to the affected area and the appearance of pain.

Classification

The classification of radicular syndrome takes into account the topography of pinched nerves (cervical, thoracic, lumbar, etc.).

Depending on the nature of the lesion, three main types of radiculopathy are distinguished:

• discogenic – the most common type, occurs with disc herniations, with a long course, the risk of paralysis is high;

• vertebrogenic – pinched nerve in stenotic foraminal openings, requires urgent medical attention;

• mixed – the nerve is infringed due to deformation of the intervertebral disc and osteophytes on the vertebral bodies.

Symptoms of radicular syndrome of the lumbar spine

The clinical picture of radicular syndrome is variable, it consists of different symptoms of damage to a particular root. The severity of the signs of the disease depends on the degree of root compression, the anatomical features of the nerve trunks, the topography of the fibers, and is determined by intersegmental connections.

A characteristic sign of the development of radicular syndrome in osteochondrosis is pain in the area of ​​nerve damage: in the neck, back, lower back. The pain can also be reflected in other parts of the body and appear as a headache, pain in the heart and stomach, pain in the buttock. With radicular syndrome, movements are difficult due to pain, it becomes difficult to perform the usual work and even just move your arms or legs. Pain can constantly disturb a person, developing into a chronic one, and intensify with careless movement or hypothermia. Sometimes in the area of ​​​​damage to the nerve there are backaches, which are accompanied by sharp acute pain. During this period, a person practically cannot move, general well-being worsens.

The pain syndrome is aggravated by any tension in the muscles and ligaments where there is a lesion. To avoid discomfort, you can take certain postures of the body, you can also limit movement in the painful area. Radicular syndrome can lead to a distortion of the body or the formation of torticollis, so timely treatment is necessary.

Loss of functions of the spine manifests itself at a late stage of root damage. They are manifested by paresis, a decrease in reflexes in the tendons (hyporeflexia), there is a decrease in sensitivity in the area of ​​​​branching of the nerves affected by osteochondrosis. When performing certain manipulations, there is a clear violation of sensitivity compared to another part of the spine.

With osteochondrosis with radicular syndrome, there is a movement disorder. This is due to the development of the pathological process in the muscles against the background of the affected nerves. Muscles weaken and if measures are not taken in time, trophic disorders will begin to develop, causing muscle hypertrophy, thinning, the body and bones will become more vulnerable and the skin will stop regenerating.

This article is advisory in nature. Treatment is prescribed by a specialist after consultation.

Symptoms of damage to individual roots

Fig. 1 Inflammation of the nerve roots of the spine

• C1. Characterized by pain in the back of the head, along with dizziness and nausea, while the head is tilted to the affected side. If this root is disrupted, the suboccipital muscles are tense, and they cause discomfort.

• C2. Pain is caused in the suboccipital and parietal region, while turning the head is very painful, the sensitivity of the skin of the occiput decreases.

• C3. Occipital and lateral neck pains radiating to tongue, orbit, or forehead. In all these zones, there is a decrease in the sensitivity of the skin and paresthesias are localized. It is difficult and painful to tilt and unbend the head.

• C4. There is pain in the shoulder girdle and on the surface of the chest. The disease spreads along the surface of the neck and can lead to hiccups or a phonation disorder.

• C5. It manifests itself in pain in the shoulder girdle and in the entire shoulder in the form of sensory disorders. Abduction of the shoulder is disturbed and hypotrophy of the deltoid muscles occurs, reflexes decrease.

• C6. The pain extends from the neck to the biceps to the surface of the forearms and extends to the thumbs. The sensitivity of the forearms decreases, paresis appears on the biceps, shoulder muscles and pronators, reflexes decrease.

• C7. Expressed by pain in the middle finger of the hand. The C7 root makes it impossible for the nerves of the periosteum to work, which is why the radicular syndrome is accompanied by severe pain. There is a decrease in muscle strength in the muscles, reflexes are lowered.

• C8. A rather rare disease, accompanied by pain, decreased sensitivity, weakness of reflexes and paresthesia in the inner part of the forearms, in the ring finger or little finger.

• T1-T2. There is pain in the armpits and shoulder joint, possibly spreading to the collarbone or shoulder. The disease is expressed in weakness and hypotrophy of the muscles of the hand, numbness, Horner’s syndrome and esophageal dysfunction are possible.

• T3-T6. Characterized by girdle pain in the intercostal space. May cause pain in the mammary gland or cause angina pectoris.

• T7-T8. There are pains below the scapula, which go along the intercostal space to the epigastrium. They are the cause of dyspepsia, pancreatic insufficiency and gastralgia, abdominal reflexes are reduced.

• T9-T10. Pain in the upper abdomen extends from the intercostal space, which may weaken the mid-abdominal reflexes.

• T11-T12. The most unpleasant development of the disease, which can spread to the inguinal or suprapubic area. May cause intestinal dyskinesia.

• L1. Pain in the inguinal region is observed, spreading to the quadrant of the buttocks.

• L2. The inner and front surface of the thigh suffers, weakness is pronounced when flexing.

• L3 . Severe pain in the lower part of the thigh, which comes from its front surface. There is a decrease in the sensitivity of the skin above the knee, paresis is formed in the muscles of the thighs.

• L4. Pain is expressed in the anterior surface of the thigh, knee joints, shins and ankles, muscle wasting is also observed. Possible rotation of the foot due to paresis, knee reflexes are reduced.

• L5. Radicular disease is accompanied by pain on the surfaces of the thigh and on the first 2 toes. There are paresis of the big toe or the entire foot, muscle wasting.

• S1. The appearance of pain in the lumbar region and the sacrum, which extends to the thighs, shins, feet and toes. The radicular syndrome proceeds with malnutrition and hypotension, weakening of rotation, it is difficult to bend the foot, the Achilles reflex does not work well.

• S2. There is paresthesia and pain in the sacrum extending to the shins, soles, thumbs and thighs. Accompanied by convulsions, and reflexes do not change.

• S3-S5. As a rule, 3 roots are affected at once. The disorder is accompanied by pain and anesthesia in the sacrum or perineum, and dysfunction of the pelvic sphincters occurs.

The most frequently reported problems are:

• Headache
• Stuck neck
• Spinal curvature
• Deep inspiration pain
• Flat feet
• Facial pain

900 20 Back pain after exercise

• Feeling dizzy
• Jaw pain

consultation based on MRI images

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How to diagnose

after assessing complaints, developmental history, functional samples and an external examination, the doctor can send the patient to undergo:

• 1

  magnetic resonance imaging.

  MRI for radicular syndrome of the spine shows: hernias, protrusions, degenerative changes in the vertebrae, osteophytes, developmental anomalies, decreased height of the intervertebral disc, osteoarticular tuberculosis, ankylosis, tumors, displacement of the vertebrae, etc.

• 2

  Computer scan.

  CT better demonstrates bone structures and is more suitable for assessing fresh trauma, deformities.

• 3

  Electroneuromyography.

  Evaluation of impulse conduction along the nerves in response to electric current stimulation makes it possible to establish the nature and extent of the pathological process.

Causes

Any morphological formations or pathological processes that lead to a compression effect on the nerve root can cause radicular syndrome.

The main causes of lumbar radiculopathy are:

• A disc herniation or protrusion can put pressure on the nerve root and cause inflammation in the root area.

• A degenerative disease of the spinal joints resulting in the formation of bony spikes at the facet joints, which can lead to narrowing of the intervertebral space, which will compress the nerve root.

• Trauma or muscle spasm can put pressure on the nerve root and cause symptoms in the area of ​​innervation.

• A degenerative disease of the discs that results in wear of the intervertebral disc structure and reduced disc height, which can lead to reduced space in the intervertebral foramen and compression of the root at the exit of the spinal column.

• Spinal stenosis

• Tumors

• Infections or systemic diseases

In patients younger than 50 years, the most common cause of radicular syndrome in the lumbar spine is a herniated disc. After 50 years, radicular pain is often caused by degenerative changes in the spine (stenosis of the intervertebral foramen).

Make an appointment with a neurologist

Appointment lasts 60 minutes, includes diagnostics, analysis of your MRI and preparation of a treatment plan, takes place both in person and online.

Treatment

• 1

  Rest and pharmacotherapy

  exercise, taking painkillers and anti-inflammatory drugs, muscle relaxants, if the disease occurs with degenerative-dystrophic diseases and pain the syndrome is pronounced, rest, analgesic therapy with drugs is prescribed. Medications such as ibuprofen, ketorolac and diclofenac are used. Drugs aimed at stopping the syndrome and decongestants, such as furosemide, are also prescribed.

  Medicines are prescribed to improve blood circulation, for example, horse chestnut extract, aminofillin, troxerutin. Drugs high in vitamin C and chondroitin sulfate and drugs to improve neural communication, such as neostigmine, may be prescribed.

  Antidepressants may be prescribed for long-term illness. If the pain is accompanied by neurotrophic disorders, then ganglion blockers are also prescribed. If the patient has muscle atrophy, medications with vitamin E may be prescribed.

  It is unacceptable to lift weights, make sharp bends, lifts, twists of the body.

• 2

  Wearing a corset

  A special corset helps with acute pain, unloading bone and muscle structures with a decrease in the load on the roots. Any orthopedic products for the back should be selected by a doctor, who also gives recommendations on the duration of wearing a corset.

• 3

  Physiotherapy

  Physiotherapeutic procedures during the rehabilitation period, such as sulphide baths, radon baths, mud therapy and paraffin therapy in the treatment of radicular syndrome, reduce the severity of pain, stopping the inflammatory process. For the best effect, a course of procedures is recommended (for example, UHF, magnetotherapy, electrophoresis with medicinal substances).

• 4

  Massage

  Massage well relaxes spasmodic muscles, eliminates muscle-tonic tension. The specialist uses different techniques – rubbing, stroking, pinching, etc. Acupressure eliminates trigger points, helps to break the reflex mechanism for maintaining pain.

• 5

  Manual therapy

  Gentle but effective manual techniques improve joint mobility, remove functional blocks and clamps. Excessive fascial tension is removed, the sensitivity of numb tissues is gradually restored, pain subsides.

• 6

  Reflexology

  Acupuncture, auriculotherapy, vacuum reflexology, hirudotherapy effectively relieve pain and have a minimum of contraindications. These techniques can be used both in the acute and in the rehabilitation period, having a beneficial effect on the entire body.

• 7

  Therapeutic exercise

  Individually selected physical therapy exercises include warm-up, stretching, strengthening the muscle corset of the whole body. Already after the first course of procedures, the range of motion in the joints increases, tendon reflexes improve, and compression on the spine decreases.

  In order to achieve a stable remission and restore the functionality of the spine and motor activity in full, it is necessary that the patient, after undergoing a course of treatment, continue independent exercises aimed at stabilizing the spine. The exercise program should be individual.
  Comprehensive treatment of radicular syndrome allows you to reduce or completely eliminate pain, restore the functions of organs and systems, and achieve long-term remission at the chronic stage of the disease.

  Already developed osteochondrosis is almost impossible to cure completely. With adequate therapy, it is possible to achieve a long-term remission, which can last for years and even decades. However, in order to exclude an exacerbation of osteochondrosis, it is necessary to reconsider your lifestyle and strictly follow the doctor’s recommendations.

• Surgical treatment

Surgical treatment may be indicated if conservative treatment fails and symptoms continue to progress. In this case, an operation is performed by experienced neurosurgeons, the purpose of which is to remove root compression and its causes. In the case of hernias, a discectomy or microdiscectomy may be prescribed, and the tumors are removed. In case of instability of the radicular syndrome, the spine is fixed.

Some surgical procedures used to treat lumbar radiculopathy:

• Vertebral fixation (spinal fusion – anterior and posterior)
• Lumbar laminectomy
• Lumbar microdiscectomy
• Laminotomy
• Transforaminal lumbar intercorporeal fusion
• Cage implantation
• Deformity correction

Preventive measures

The development of radicular syndrome in the lumbosacral spine can be prevented. To reduce the chance of developing this condition:

• Practice good posture while sitting and standing, including while driving.

• Use proper body mechanics when lifting, pushing, pulling, or performing any activity that puts additional stress on the spine.

• Maintain a healthy weight by eating a balanced diet that includes all the necessary microelements and vitamins for the normal functioning of the body. This will reduce the load on the spine.

• Refusal of bad habits.

• Discuss your occupation with an exercise therapist who can analyze work movements and suggest steps to reduce the risk of injury.

• Muscles must be strong and elastic. Sufficient levels of physical activity must be consistently maintained.

• Competent organization of the bed. Sleep on an orthopedic mattress, choose a low pillow.

• Wear comfortable shoes (high heels are recommended).

Compliance with simple rules has a positive effect on the patient’s condition, prevents the formation of many pathologies, including radicular syndrome of the spine. Take care of your health, in case of specific symptoms, consult a doctor, start the necessary treatment.

List of sources:

1. Kukushkin M.L., Tabeeva G.R., Podchufarova E.V. Pain syndrome: pathophysiology, clinic, treatment. Clinical guidelines. Ed. Yakhno N.N. 2nd ed. Moscow: IMA-press; 2014. – 72 p.
   
2. Non-specific pain in the lower back. Guidelines for the Moscow Department of Health. M.: 2014, 32 p.
   
3. Arestov S.O., Gushcha A.O., Kashcheev A.A. Algorithm for the treatment of patients with pain in the lumbar region. Russian Medical Journal 2012;20(31):1540-2. [Arestov SO, Gushcha AO, Kashcheev AA. Algorithm for the treatment of patients with pain in the lumbar region. Russian Medical Journal 2012;20(31):1540-2 (In Russian)].
   
4. Davydov O.S., Yakhno N.N., Kukushkin M.L. Neuropathic pain: clinical guidelines for the diagnosis and treatment of the Russian Society for the Study of Pain. Russian journal of pain. 2018;4(58):5–41. [Davydov O.S., Yakhno N.N., Kukushkin M.L. Neuropathic pain: clinical guidelines for the diagnosis and treatment of the Russian Society for the Study of Pain. Russian journal of pain. 2018;4(58):5–41 (in Russ.)]. DOI: 10.25731/RASP.2018.04.025.
   

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Radicular syndrome – Spina Zdorova Clinic

What is radicular syndrome?

Radicular syndrome is not just pain in the leg or arm due to problems in the spine. This radicular syndrome has a number of very characteristic features, and if there are none, then pain in the leg or arm is not a radicular syndrome at all, but something else. Agree, if one of us just clears his throat, it is not at all necessary that it is pneumonia. So here – it should be understood that the real radicular syndrome is not just any pain in the leg or arm, but a very specific pathology with its clear symptoms. Not every severe pain in the leg or arm is a radicular syndrome.

31 pairs of nerves emerge from the spine. These nerves originate from the spinal cord, so they are called spinal nerves. Although, earlier they were called – nerve roots, which, in fact, gave the name to the radicular syndrome.

Each pair of spinal nerves corresponds to a segment of the spinal cord (in medicine it is conventional to divide the spinal cord into 31 segments). 8 pairs of cervical, 12 pairs of thoracic, 5 pairs of lumbar, 5 pairs of sacral and 1 pair (sometimes 2 pairs) of coccygeal nerves. Moreover, each nerve has its own designation. For example, cervical are denoted by the Latin letter “C”, from the word Cervix – neck and a number from 1 to 8 (C1 – C8). Thoracic – “Th” – Thorax – chest and number from 1 to 12 (Th2 – Th22). Lumbar – “L” – Lumbus – lower back and a number from 1 to 5 (L1 -L5). Sacrum – “S” – Sacrum – sacrum and a number from 1 to 5 (S1 – S5). Coccygeal – Co – Coccygeus – coccyx and the number 1-2 (Co1 – Co2).

Let’s once again focus our attention on the fact that the root and the spinal nerve are completely different things. But, it just so happened that the pathology that occurs when the spinal nerve is compressed is called the radicular syndrome.

To understand the essence of the radicular syndrome and not call any pain in the leg or arm that way, you need, at least in general terms, to understand how the spinal nerve works, what is the root, what types of nerve fibers exist, what is a segment of the spinal cord and zone of segmental innervation. And about all this – read below.

How is the spinal nerve arranged?

The root is the initial and very short section of the nerve that emerged from the spinal cord, but, at the same time, is located inside the spine. In the same place, inside the spine, the roots of two different types are interconnected and form the spinal nerve, which, in fact, comes out of the spine.

The root, like the rest of the nerve, consists of many nerve fibers bundled like a stranded wire. There are back and front roots. The posterior roots are composed of sensory nerve fibers. The anterior roots are composed of motor nerve fibers.

Sensory fibers transmit pain impulses and all other sensations, such as heat and cold, touch, vibration, etc. to the brain.

Motor fibers transmit commands from the brain to our muscles.

Connecting with each other, the anterior and posterior roots form the spinal nerve. Pay attention to this – the spinal nerve combines both types of nerve fibers – sensory and motor, that is, it is a mixed nerve. Please remember this fact. We will need it for further disclosure of the essence of the radicular syndrome.

What is the zone of segmental innervation?

After leaving the spine, each spinal nerve branches into nerves, like a tree trunk into branches. Further, these nerves go to a certain area of ​​the body to provide innervation (nervous regulation) there. The area of ​​the body that is innervated by nerves from one segment is called the zone of segmental innervation.

For example, the C5 spinal nerve innervates the C5 area, and the L4 nerve innervates the L4 area, etc. And, pay attention, the nerve branches extending from each spinal nerve provide both types of innervation in their zone – both sensory and motor. Let’s take a closer look at this figure. It shows the zones of segmental innervation. As you can see, everything is simple and clear.

Zones of segmental innervation

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What is the essence of radicular syndrome?

As we found out, the spinal nerve contains sensory and motor fibers. Therefore, if something presses on the nerve, for example, a herniated disc, this will affect both the sensory and motor areas. Violation of sensitivity will be manifested by numbness, burning, needles, goosebumps and severe pain. And in the motor sphere – there will be a weakening of the muscles, their tone and reflexes will decrease. By the way, the sensations in radicular syndrome, exactly the same, resemble those that occur if you “sit out” the leg. The leg becomes wadded and, as it were, fails when you try to stand on it, it goes numb and pricks with needles. Only with radicular syndrome, these sensations are much stronger and, unlike the “oversitting” leg, they do not go away on their own, but require urgent treatment. With radicular syndrome, in addition to pain and numbness, muscle weakness always occurs.

Where does radicular syndrome manifest itself?

As we have already found out, nerve impulses from the spinal nerve diverge throughout the entire zone of innervation of this nerve. Consequently, when squeezing the nerve, pain, muscle weakness, numbness, needles and goosebumps will cover the entire area. It does not happen that the radicular syndrome gives pain only in places, and in the rest of the zone there is no pain. Remember radicular syndrome – these are simultaneous manifestations of pain, muscle weakness, numbness and other symptoms, covering the entire zone of innervation as a whole.

In medical terms, radicular syndrome is:

• Loss of sensation (pins and needles, goosebumps, pain)
• Muscle hypotension (weakness)
• Reduced or complete loss of muscle reflexes

All of the above symptoms develop within the zone of innervation of the corresponding spinal nerve.

Causes of radicular syndrome

Most people associate the phrase “radicular syndrome” with a herniated disc, protrusion or osteochondrosis. But, contrary to such a widespread and equally erroneous opinion, radicular syndrome is not at all a key feature of these particular diseases. The presence of radicular syndrome, only indicates that the spinal nerve is under the influence of some pathology, and which one is already a matter of further clinical analysis. Radicular syndrome is the main clinical sign of damage to the spinal nerve.

Usually, radicular syndrome occurs with more severe pathologies than osteochondrosis. The most common causes of radicular syndrome are either circulatory disorders (radicular vascular syndrome, spinal stroke, ischemic radiculopathy) or mechanical effects (bone fragments in a spinal fracture, benign or malignant tumor, cyst, etc.). Although, in fairness, it must be said that with osteochondrosis, disc herniation and protrusion, radicular syndrome also occurs, but extremely rarely and mainly in the cervical region.

Mistakes in diagnosing radicular syndrome

A common mistake is that radicular syndrome is often confused with pseudoradicular syndrome. Pseudoradicular syndrome is pain caused not by compression of the spinal nerve, but by muscle disease.

There is a muscle disorder called myofascial syndrome. We have a detailed article about it on our website. And, in short – with myofascial syndrome, small spasmodic areas appear in the muscles – trigger points that cause very severe pain. Sometimes the zone of myofascial pain can cover quite extensive areas of the body and resemble the lesion of the zone of segmental innervation in radicular syndrome. For example, pain from the lower back may radiate down the leg to the thigh and lower leg. In such cases, it is customary to use the term “pseudoradicular syndrome”. The figure below shows the zone of radicular syndrome L4 – highlighted in blue and the zone of pain in myofascial syndrome of the small gluteal muscle – in red. Moreover, the localization of myofascial pain in the gluteus maximus muscle can have two options.

Areas of pain. Root – blue. Myofascial – orange

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Isn’t it true that the L4 radicular pain zone and the gluteus maximus myofascial pain zone are very similar to each other? Therefore, in this and many other cases, inexperienced doctors often confuse the manifestations of radicular and pseudoradicular (myofascial) syndromes. Just like an inexperienced mushroom picker runs the risk of confusing real and false mushrooms.