Lumbar nerve root map: The request could not be satisfied
Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps?
This prospective study consisted of mechanical stimulation of cervical nerve roots C4 to C8 in patients with cervical radicular symptoms undergoing diagnostic selective nerve root block.
To document the distribution of pain and paresthesias that result from stimulation of specific cervical nerve roots and compare that distribution to documented sensory dermatomal maps.
Summary of background data:
Cervical dermatomes were first studied in the late 19th century. The results of those studies underpin current clinical decision making for patients with neck and arm pain. However, it has been observed that patients with radicular symptoms may have cervical pathology by radiographic imaging that is not corroborative, or have imaging studies that suggest a lesion at a level other than the one suggested by the patient’s dermatomal symptoms. These observations may suggest that cervical dermatomal mapping is inaccurate or the distribution of referred symptoms (dynatome) from cervical root irritation is different than the sensory deficit outlined by dermatomal maps.
Inclusion criteria consisted of consecutive patients undergoing fluoroscopically guided diagnostic cervical selective nerve root blocks from C4 to C8. Immediately preceding contrast injection, mechanical stimulation of the root was performed. An independent observer interviewed and recorded the location of provoked symptoms on a pain diagram. Visual data was subsequently compiled using a 793 body sector bit map. Forty-three clinically relevant body regions were defined on this bit map. Frequencies of symptom provocation and likelihood of symptom location from C4 to C8 stimulation of each nerve root were generated.
One hundred thirty-four cervical nerve root stimulations were performed on 87 subjects. There were 4 nerve root stimulations at C4, 14 at C5, 43 at C6, 52 at C7, and 21 at C8. Analyzing the frequency of involvement of the predetermined clinically relevant body regions either individually or in various combinations yielded more than 1,000 bits of data. Although the distribution of symptom provocation resembled the classic dermatomal maps for cervical nerve roots, symptoms were frequently provoked outside of the distribution of classic dermatomal maps.
The current study demonstrates a distinct difference between dynatomal and dermatomal maps.
Dermatome Chart 101: Understanding Spinal Nerves, Locations
An improved understanding of the human body and the way our nerves supply us with feedback, about both the outside world and the inner workings of our biology, can help patients recognize why and how they’re feeling pain, and what their treatments and therapies are trying to achieve. When mapping and tracing origins of pain, the dermatome chart plays an important role in the diagnostic process.
Skin is your body’s largest, most important sensory organ. If you feel pain in a particular area, basic anatomy can tell us what nerves supply that area, and provides why pain is being perceived there without an immediately noticeable cause. Often times, when an area feels painful without any indication of damage, there is rooted damage to the nerves in or around the area. This is where the dermatome chart becomes an essential diagnostic tool for spine specialists, doctors and patients alike.
What Are Dermatomes?
Derived from two Greek root words in “derma” (skin) and “tomos” (a slice), dermatomes refers to a section of skin supplied by a spinal nerve, starting with the cervical spine (in the neck) down to the sacrum (the base of our pelvis). These areas are not perfectly exact, and multiple nerves may innervate a single general area. But this guide does provide a general overview of what nerve may be responsible for pain or lack thereof, and helps us better assess and diagnose spinal injury.
The spine is divided into 33 vertebrae, 31 of which have corresponding nerve pairs that innervate specific sections of the body. Of these, 30 are linked to corresponding dermatomes. The topmost cervical nerve attached to the C1 does not have a corresponding dermatome (it helps control neck and head movement, along with the other cervical nerves). The spinal nerves and their corresponding dermatomes are as follows:
- (Cervical) C2 – forehead, and temple
- C3 – neck, posterior cheek
- C4 – shoulders, clavicle, upper shoulder blade
- C5 – deltoids, anterior arm (facing forward) down to the base of the thumb
- C6 – anterior arm as well as the radial side of the hand
- C7 – lateral arm and forearm (facing away from the center) to index, middle, and ring finger
- C8 – medial arm and forearm (facing toward the center) to the middle, ring, and little finger
- (Thoracic) T1 – medial (inner) side of the forearm to the base of the little finger
- T2 – medial (inner) side of the upper arm to the elbow, pectoral muscles (chest) and mid scapular area (between shoulder blades)
- T3-T6 – upper torso
- T5-T7 – costal margin (the portion of skin along the lower side of the ribs)
- T8-T12 – abdomen and lower back
- (Lumbar) L1 – lower back, side of the hip (trochanter), and groin
- L2 – back, front of the thigh (quadriceps) to knee
- L3 – back, upper buttock, front of thigh and knee, inner lower leg (the medial portion of the calves)
- L4 – inner buttock, lateral thigh, inner thigh, dorsal (top) side of the foot, the big toe
- L5 – buttocks, posterior (back) and lateral thigh, lateral side of the entire leg, top of foot, medial (inner) side of the sole, toes
- (Sacral) S1-S2 – buttocks, thighs, and backside of the legs
- S3 – groin, inner thigh
- S4 – perineum and genitals
Not included in the list above is the face, which is innervated by the trigeminal nerve, which is a set of cranial nerves rather than a spinal nerve. Note that the dermatomes of the face are still dermatomes, but because they aren’t innervated by spinal nerves as the rest of the body is, they are not affected by spinal injury and diseases of the spinal cord.
When visualizing dermatomes, it helps to think of the body’s skin as divided into a long series of rings encompassing us from head to toe, with each spinal nerve corresponding to a ring of skin, with certain exemptions.
All dermatomes, save for those of the face, are divided between the four major sections of the spine. When utilizing dermatomes as a diagnostic tool, being able to identify clearly where it hurts or recognizing when a specific dermatome feels numb or unresponsive can help doctors narrow down the potential culprit along the spine, and figure out an effective treatment.
Using Dermatomes as a Diagnostic Tool
The spinal column is composed of a series of tough bones, made flexible by intersecting spongy discs. The spinal cord runs through our spine, connecting to dozens of nerve roots that correspond to a set of nerves throughout the body.
Alongside the brain, the spinal cord is one of the major dividing sections of our central nervous system, coordinating with our ganglia and various nerves throughout the body (our peripheral nervous system, which includes the autonomic, enteric, sympathetic, and parasympathetic nervous systems) to regulate and manage nearly all of the body’s processes, from the release of certain chemicals to the contracting and relaxing of skeletal muscles like those in the leg, smooth muscles like those in our digestive and respiratory tracts, and the automatic pumping function of the heart.
When damage, disease, or infection leads to destroyed cells in the spine or pressure along nerve roots in the spinal cord, the pain can radiate throughout portions of the body that aren’t superficially related to the back, such as the legs, chest, and arms. Tingling feelings, sharp or burning pain, recurring aches, loss of strength, and other symptoms and sensations on the skin and in the muscles can be a sign of damage along the spine.
The Dermatome Chart Role in Evaluating and Diagnosing Conditions
The dermatome chart often play an important role in figuring out where the damage is coming from, giving doctors a hint as to where to check for signs of infection, swelling, or injury. Common diseases that may be partially identified through the dermatome chart include:
A series of other diagnostic tools and symptoms are important for identifying injuries and diseases of the spine, including paralysis, bladder dysfunction, and gait disturbance, as well as diagnostic processes such as imaging (MRI, CT, X-rays checking for bone damage) and blood tests (to check for infection).
Dermatomes play an important role in our understanding of the human body and can help patients better understand how damage to their back can be identified through various symptoms of pain and other strange or out-of-place sensations.
When the spine is damaged, treatments often include medication and intervention to reduce and combat swelling and inflammation, rest and exercise to reduce pain and strengthen the surrounding muscles, and in certain cases, surgery to remove bone spurs or fragments, or decompress a nerve root/the spinal cord.
Spine Anatomy | Mayfield Brain & Spine, Cincinnati
The spine is made of 33 individual bones stacked one on top of the other. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. Strong muscles and bones, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine. Yet, any of these structures affected by strain, injury, or disease can cause pain.
When viewed from the side, an adult spine has a natural S-shaped curve. The neck (cervical) and low back (lumbar) regions have a slight concave curve, and the thoracic and sacral regions have a gentle convex curve (Fig. 1). The curves work like a coiled spring to absorb shock, maintain balance, and allow range of motion throughout the spinal column.
Figure 1. The spine has three natural curves that form an S-shape; strong muscles keep our spine in alignment.
Figure 2. The five regions of the spinal column.
The abdominal and back muscles maintain the spine’s natural curves. Good posture involves training your body to stand, walk, sit, and lie so that the least amount of strain is placed on the spine during movement or weight-bearing activities (see Posture). Excess body weight, weak muscles, and other forces can pull at the spine’s alignment:
- An abnormal curve of the lumbar spine is lordosis, also called sway back.
- An abnormal curve of the thoracic spine is kyphosis, also called hunchback.
- An abnormal curve from side-to-side is called scoliosis.
The two main muscle groups that affect the spine are extensors and flexors. The extensor muscles enable us to stand up and lift objects. The extensors are attached to the back of the spine. The flexor muscles are in the front and include the abdominal muscles. These muscles enable us to flex, or bend forward, and are important in lifting and controlling the arch in the lower back.
The back muscles stabilize your spine. Something as common as poor muscle tone or a large belly can pull your entire body out of alignment. Misalignment puts incredible strain on the spine (see Exercise for a Healthy Back).
Vertebrae are the 33 individual bones that interlock with each other to form the spinal column. The vertebrae are numbered and divided into regions:
cervical, thoracic, lumbar, sacrum, and coccyx (Fig. 2). Only the top 24 bones are moveable; the vertebrae of the sacrum and coccyx are fused. The vertebrae in each region have unique features that help them perform their main functions.
Cervical (neck) – the main function of the cervical spine is to support the weight of the head (about 10 pounds). The seven cervical vertebrae are numbered C1 to C7. The neck has the greatest range of motion because of two specialized vertebrae that connect to the skull. The first vertebra (C1) is the ring-shaped atlas that connects directly to the skull. This joint allows for the nodding or “yes” motion of the head. The second vertebra (C2) is the peg-shaped axis, which has a projection called the odontoid, that the atlas pivots around. This joint allows for the side-to-side or “no” motion of the head.
Thoracic (mid back) – the main function of the thoracic spine is to hold the rib cage and protect the heart and lungs. The twelve thoracic vertebrae are numbered T1 to T12. The range of motion in the thoracic spine is limited.
Lumbar (low back) – the main function of the lumbar spine is to bear the weight of the body. The five lumbar vertebrae are numbered L1 to L5. These vertebrae are much larger in size to absorb the stress of lifting and carrying heavy objects.
Sacrum – the main function of the sacrum is to connect the spine to the hip bones (iliac). There are five sacral vertebrae, which are fused together. Together with the iliac bones, they form a ring called the pelvic girdle.
Coccyx region – the four fused bones of the coccyx or tailbone provide attachment for ligaments and muscles of the pelvic floor.
While vertebrae have unique regional features, every vertebra has three functional parts (Fig. 3):
Figure 3. A vertebra has three parts:
body (purple), vertebral arch (green), and processes for muscle attachment (tan).
- a drum-shaped body designed to bear weight and withstand compression (purple)
- an arch-shaped bone that protects the spinal cord (green)
- star-shaped processes designed as outriggers for muscle attachment (tan)
Each vertebra in your spine is separated and cushioned by an intervertebral disc, which keeps the bones from rubbing together. Discs are designed like a radial car tire. The outer ring, called the annulus, has crisscrossing fibrous bands, much like a tire tread. These bands attach between the bodies of each vertebra. Inside the disc is a gel-filled center called the nucleus, much like a tire tube (Fig. 4).
Figure 4. Discs are made of a gel-filled center called the nucleus and a tough fibrous outer ring called the annulus. The annulus pulls the vertebrae bones together against the resistance of the gel-filled nucleus.
Discs function like coiled springs. The crisscrossing fibers of the annulus pull the vertebral bones together against the elastic resistance of the gel-filled nucleus. The nucleus acts like a ball bearing when you move, allowing the vertebral bodies to roll over the incompressible gel. The gel-filled nucleus contains mostly fluid. This fluid is absorbed during the night as you lie down and is pushed out during the day as you move upright.
With age, our discs increasingly lose the ability to reabsorb fluid and become brittle and flatter; this is why we get shorter as we grow older. Also diseases, such as osteoarthritis and osteoporosis, cause bone spurs (osteophytes) to grow. Injury and strain can cause discs to bulge or herniate, a condition in which the nucleus is pushed out through the annulus to compress the nerve roots causing back pain.
Vertebral arch & spinal canal
On the back of each vertebra are bony projections that form the vertebral arch. The arch is made of two supporting pedicles and two laminae (Fig. 5). The hollow spinal canal contains the spinal cord, fat, ligaments, and blood vessels. Under each pedicle, a pair of spinal nerves exits the spinal cord and pass through the intervertebral foramen to branch out to your body.
Figure 5. The vertebral arch (green) forms the spinal canal (blue) through which the spinal cord runs. Seven bony processes arise from the vertebral arch to form the facet joints and processes for muscle attachment.
Surgeons often remove the lamina of the vertebral arch (laminectomy) to access the spinal cord and nerves to treat stenosis, tumors, or herniated discs.
Seven processes arise from the vertebral arch: the spinous process, two transverse processes, two superior facets, and two inferior facets.
The facet joints of the spine allow back motion. Each vertebra has four facet joints, one pair that connects to the vertebra above (superior facets) and one pair that connects to the vertebra below (inferior facets) (Fig. 6).
Figure 6. The superior and inferior facets connect each vertebra together. There are four facet joints associated with each vertebra.
The ligaments are strong fibrous bands that hold the vertebrae together, stabilize the spine, and protect the discs. The three major ligaments of the spine are the ligamentum flavum, anterior longitudinal ligament (ALL), and posterior longitudinal ligament (PLL) (Fig. 7). The ALL and PLL are continuous bands that run from the top to the bottom of the spinal column along the vertebral bodies. They prevent excessive movement of the vertebral bones. The ligamentum flavum attaches between the lamina of each vertebra.
Figure 7. The ligamentum flavum, anterior longitudinal ligament (ALL), and posterior longitudinal ligament (PLL) allow the flexion and extension of the spine while keeping the bones aligned.
The spinal cord is about 18 inches long and is
the thickness of your thumb. It runs from the brainstem to the 1st lumbar vertebra protected within the spinal canal. At the end of the spinal cord, the cord fibers separate into the cauda equina and continue down through the spinal canal to your tailbone before branching off to your legs and feet. The spinal cord serves as an information super-highway, relaying messages between the brain and the body. The brain sends motor messages to the limbs and body through the spinal cord allowing for movement. The limbs and body send sensory messages to the brain through the spinal cord about what we feel and touch. Sometimes the spinal cord can react without sending information to the brain. These special pathways, called spinal reflexes, are designed to immediately protect our body from harm.
Any damage to the spinal cord can result in a loss of sensory and motor function below the level of injury. For example, an injury to the thoracic or lumbar area may cause motor and sensory loss of the legs and trunk (called paraplegia). An injury to the cervical (neck) area may cause sensory and motor loss of the arms and legs (called tetraplegia, formerly known as quadriplegia).
Thirty-one pairs of spinal nerves branch off the spinal cord. The spinal nerves act as telephone lines, carrying messages back and forth between your body and spinal cord to control sensation and movement. Each spinal nerve has two roots (Fig. 8). The ventral (front) root carries motor impulses from the brain and the dorsal (back) root carries sensory impulses to the brain. The ventral and dorsal roots fuse together to form a spinal nerve, which travels down the spinal canal, alongside the cord, until it reaches its exit hole – the intervertebral foramen (Fig. 9). Once the nerve passes through the intervertebral foramen, it branches; each branch has both motor and sensory fibers. The smaller branch (called the posterior primary ramus) turns posteriorly to supply the skin and muscles of the back of the body. The larger branch (called the anterior primary ramus) turns anteriorly to supply the skin and muscles of the front of the body and forms most of the major nerves.
Figure 8. The ventral (motor) and dorsal (sensory) roots join to form the spinal nerve. The spinal cord is covered by three layers of meninges: pia, arachnoid and dura mater.
The spinal nerves are numbered according to the vertebrae above which it exits the spinal canal. The 8 cervical spinal nerves are C1 through C8, the 12 thoracic spinal nerves are T1 through T12, the 5 lumbar spinal nerves are L1 through L5, and the 5 sacral spinal nerves are S1 through S5. There is 1 coccygeal nerve.
Figure 9. The spinal nerves exit the spinal canal through the intervertebral foramen below each pedicle.
The spinal nerves innervate specific areas and form a striped pattern across the body called dermatomes (Fig. 10). Doctors use this pattern to diagnose the location of a spinal problem based on the area of pain or muscle weakness. For example leg pain (sciatica) usually indicates a problem near the L4-S3 nerves.
Figure 10. A dermatome pattern shows which spinal nerves are responsible for sensory and motor control of specific areas of the body.
Coverings & spaces
The spinal cord is covered with the same three membranes as the brain, called meninges. The inner membrane is the pia mater, which is intimately attached to the cord. The next membrane is the arachnoid mater. The outer membrane is the tough dura mater (Fig. 8). Between these membranes are spaces used in diagnostic and treatment procedures. The space between the pia and arachnoid mater is the wide subarachnoid space, which surrounds the spinal cord and contains cerebrospinal fluid (CSF). This space is most often accessed when performing a lumbar puncture to sample and test CSF or during a myelogram to inject contrast dye. The space between the dura mater and the bone is the epidural space. This space is most often accessed to deliver anesthetic numbing agents, commonly called an epidural, and to inject steroid medication (see Epidural Steroid Injections).
Sources & links
If you have more questions, please contact the Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.
dorsal: the back or posterior side of the body.
kyphosis: an abnormal forward curvature of the thoracic spine, also called hunchback.
lordosis: an abnormal curvature of the lumbar spine, also called swayback.
paraplegia: paralysis of both legs and lower body below the arms indicating an injury in the thoracic or lumbar spine.
quadraplegia: paralysis of both legs and arms indicating an injury to the cervical spine.
scoliosis: an abnormal side-to-side curvature of the spine.
ventral: the front or anterior side of the body.
updated > 9.2018
reviewed by > Tonya Hines, CMI, Mayfield Clinic, Cincinnati, Ohio
Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider.
Lumbar Radiculopathy | McGovern Medical School
What is Lumbar Radiculopathy?
Lumbar radiculopathy, commonly called sciatica, is an injury to the nerve in the lower back that causes pain and numbness that radiates down the legs. Symptoms also may include tingling, weakness, and reflex loss in the leg and feet. A nerve root in any of the five lumbar vertebrae can be damaged, irritated, or compressed by one of many conditions, including tumors, infections, disk herniation, spinal stenosis, and cervical radiculopathy.
Both non-surgical and minimally invasive treatment options may be available to alleviate lumbar radiculopathy.
Causes of Lumbar Radiculopathy
Most commonly, people ages 30-50 experience lumbar radiculopathy because of degenerative conditions that appear or worsen with age, such as arthritis and osteoarthritis. Bone spurs, herniated disks, and spinal stenosis may cause a compression of the spinal canal, contributing to lumbar radiculopathy. Tumors of the spine or infections can also cause the condition.
Early Signs of Lumbar Radiculopathy and Diagnosis
Sciatica varies in intensity, frequency, and
duration. Symptoms include a sharp or burning pain that travels down the leg
and makes walking and standing uncomfortable; sharp or burning pain that
worsens when sitting; a steady pain in one leg or buttock; muscle spasms;
numbness in the feet and legs; and a feeling of weakness in the legs or
difficulty moving the lower extremities.
Our spine specialists diagnose sciatica with X-ray, MRI, or CT scans, and electromyography to test nerve function.
What to expect during treatment for Lumbar Radiculopathy
Your doctor may use X-rays, CT scans, an MRI, or an electromyography, as well as a physical exam, to determine the severity of your lumbar radiculopathy. The condition is often treatable through non-surgical options, such as medication and physical therapy. Pain medication and corticosteroids, which relieve inflammation, are often effective in reducing symptoms. Surgical intervention may be considered if these more conservative treatments fail to provide relief.
The treatment your doctor recommends will depend on the cause and severity of your lumbar radiculopathy, as well as other factors. Surgical options that would either decompress the nerve or stabilize the spine and might include a fusion or lumbar laminectomy. The vast majority of patients who undergo surgery experience relief from their symptoms.
Contact Us »
Request Appointment »
What You Can Expect at UTHealth Neurosciences
The UTHealth Neurosciences Spine Center brings together a multidisciplinary team of board-certified, fellowship-trained neurosurgeons, neurologists, researchers, and pain management specialists who work together to help provide relief for even the most complex problems. Your team will share insights, leading to better treatment decisions and outcomes.
We first investigate nonsurgical treatment options, including medical management, pain management, physical therapy, rehabilitation, and watchful waiting. When surgery is needed, our neurosurgeons routinely employ innovative minimally invasive techniques. Throughout the treatment process, we will work closely with the doctor who referred you to ensure a smooth transition back to your regular care. While you are with us, you will receive expert care, excellent communication, and genuine compassion.
Anatomy of the neck and spine
The spine is divided into the following regions:
- The cervical region (vertebrae C1-C7) encompasses the first seven vertebrae under the skull. Their main function is to support the weight of the head, which averages 10 pounds. The cervical vertebrae are more mobile than other areas, with the atlas and axis vertebra facilitating a wide range of motion in the neck. Openings in these vertebrae allow arteries to carry blood to the brain and permit the spinal cord to pass through. They are the thinnest and most delicate vertebrae.
- The thoracic region (vertebrae T1-T12) is composed of 12 small bones in the upper chest. Thoracic vertebrae are the only ones that support the ribs. Muscle tension from poor posture, arthritis, and osteoporosis are common sources of pain in this region.
- The lumbar region (vertebrae L1-L5) features vertebrae that are much larger to absorb the stress of lifting and carrying heavy objects. Injuries to the lumbar region can result in some loss of function in the hips, legs, and bladder control.
- The sacral region (vertebrae S1-S5) includes a large bone at the bottom of the spine. The sacrum is triangular-shaped and consists of five fused bones that protect the pelvic organs.
Spine Disease and Back Pain
At UTHealth Neurosciences, we offer patients access to specialized neurological care at clinics across the greater Houston area. To ask us a question, schedule an appointment, or learn more about us, please call (713) 486-8100, or click below to send us a message. In the event of an emergency, call 911 or go to the nearest Emergency Room.
Contact Us »
Nerve Monitoring Arkansas | Electromyogram
What is Nerve Mapping?
Nerve Mapping is a method of precisely locating nerves and measuring their function in real-time during surgery. This allows the surgeon to reduce the risk of nerve injury and assess nerve health intra-operatively.
Nerves control the muscles in the body by sending electrical signals called impulses. These impulses make the muscles react in specific ways. These impulses can be used to assess and map nerves, and nerve health.
Why Use Nerve Mapping?
The NeuroSurgery Spine Center uses a new, cutting edge technology called Mechanomyography, or MMG, to map the nerves and nerve structures during surgery. This technology helps the surgeon locate and avoid nerves and nerve roots with great accuracy, helping manage risk during the surgical procedure.
How does MMG work?
MMG smart-sensors are adhered to the surface of the patient’s skin directly overtop the muscles. There are neither invasive needles nor special skin preparation for the placement of the smart-sensors. During surgery, the surgeon uses a small tool to stimulate the nerves.When a nerve is located, the surgeon is provided with a ‘STOP’ alert.When no nerve response is present, the surgeon receives a “GO” indication.
SentioMMG® Nerve Mapping System
Nerve Conduction Studies
Nerve conduction studies are performed to:
Assess disorders of the peripheral nervous system which includes the nerves that lead away from the brain and spinal cord and the smaller nerves that branch off from those nerves. Nerve conduction studies are often used to help diagnose nerve disorders such as pinched nerves, carpal tunnel syndrome or Guillain-Barre syndrome.
Both EMG and nerve conduction studies can help diagnose a condition called post-polio syndrome that may develop months to years after a person has had polio.
How to Prepare?
Inform your doctor regarding the following:
- Medications: Certain medicines that act on the nervous system can change electromyogram (EMG) results. You may need to stop taking these medicines 3 to 6 days before the test.
- Bleeding: If you have a history of bleeding problems or take blood thinners, such as coumadin, heparin, or aspirin, your doctor will tell you when to stop taking them before the test.
- Pacemaker: Let your doctor know if you have a pacemaker. Generally, this is not a problem, but nerve conduction stimulation will be avoided near the pacemaker.
- Smoking: Do not smoke for 3 hours before the test.
- Lotions: Do not apply lotion to the arms or legs on the day of the test.
How is the Procedure Performed?
Electromyogram: During the electromyography test, the physician cleans the skin with alcohol and inserts a tiny needle with an electrode into the muscle. The electrical activity of the muscle is recorded and viewed on a screen called an oscilloscope. The physician analyzes the activity on the screen and listens to the sounds of the activity through a speaker. This helps the physician determine if there are abnormalities in the muscle or the nerve going to the muscle.
Electromyogram: An EMG may take 30 to 60 minutes. When the testing is complete, the electrodes are removed and the injection sites are cleaned with alcohol.
Nerve conduction studies: In this test, several flat metal disc electrodes are attached to your skin with tape or a special paste. A shock-emitting electrode is placed directly over the nerve and a recording electrode is placed over the muscles under control of that nerve. Several quick electrical pulses are sent to the nerve. The time it takes for the muscle to contract in response to the electrical pulse is then recorded.
Nerve conduction studies: The speed of muscle contraction response is called the conduction velocity.
Nerve conduction studies are done before an EMG if both tests are being performed. Nerve conduction tests may take from 15 minutes to 1 hour or more, depending on how many nerves and muscles are studied.
What are the Risks?
An electromyogram (EMG) is very safe. You may have some pain in the muscles after the procedure or small bruises or swelling at the needle injection sites. Sterile technique is used so there is very little chance of developing an infection at the injection sites.
There are no risks associated with nerve conduction studies. Since it is a non-invasive procedure, there is no chance of infection. The voltage associated with the electrical pulses is not high enough to cause an injury.
Although every effort is made to educate you on ELECTROMYOGRAM and take control, there will be specific information that will not be discussed. Talk to your doctor or health care provider about any concerns you have about ELECTROMYOGRAM.
Sciatica or Radicular Leg Pain – Welcome Back Clinic
Sciatica refers to the experience of pain in the distribution of the sciatic nerve. The pain usually radiates from the buttock down the leg to the foot. Sciatica is caused by the compression or irritation of a nerve root in the lumbar spine. The distribution of the pain depends on which nerve root is affected. It is rarely due to irritation of the sciatic nerve itself.
Signs and symptoms:
The major symptom is pain which can be excruciating. The onset of pain is often sudden and may be related to a specific event such as bending and twisting of the spine. However in many cases there is no specific injury that can be attributed to the onset of the pain. In some cases there is a specific cause such as heavy lifting, a fall or a motor vehicle accident. The pain is intense and persistent. Clients often have trouble finding a position which will improve the pain. Pain killers are often prescribed but usually do not provide complete relief of the pain. Leg pain is the major symptom. Some people also experience back pain. In some people they experience back pain for hours or days before the onset of the leg pain. However the leg pain is usually much worse than the back pain. Straightening the affected leg will often make the pain worse. Lying down with the knees bent can improve the pain. Coughing, sneezing or straining while going to the bathroom often makes the pain worse. In addition to the leg pain, clients can experience numbness in part of the leg. If the nerve root is severely compressed people can also experience weakness in one or more muscles in the leg. However most people only experience pain with no or little numbness and no weakness. The distribution of the pain, numbness and weakness can help identify which nerve root is being irritated. In severe cases the bladder or bowel can also be affected. This is referred to as cauda equina syndrome and is considered a true emergency and requires immediate investigation and treatment.
The two most common nerve roots that are affected are the fifth lumbar (L5) and the first sacral (S1) roots. Each has a specific distribution of the pain, numbness and weakness. An L5 radiculopathy causes pain that radiates from the buttock down the leg to the outside of the ankle and into the top of the foot toward the big toe. People experience numbness on the outside of the ankle and top of the foot. Weakness in the muscle that bends the ankle backwards results in a footdrop. This can often be detected by a slapping of the foot that occurs with each step. People often trip over small elevations because they are unable to lift their foot when they walk. An S1 radiculopathy causes pain that runs from the buttock through the pack of the thigh and into the calf and outside of the foot. The numbness is usually experienced on the outside of the foot. The weakness, when present involves the hamstring muscle which bends the knee and the calf muscle which bends the foot downward. If the S1 nerve root is affected the person may also have an absent ankle reflex when tested by their doctor. The 4th lumbar nerve root (L4) is the 3rd most frequently affected nerve and results in pain that radiates through the lateral thigh and the inside of the lower leg. Numbness usually occurs on the outside of the thigh. The thigh muscle can be weak and the knee reflex can be decreased or absent.
The most common cause of sciatica is a disc herniation in the lumbar spine.
The most common levels in the spine where disc herniations occur, is between the 4th and 5th lumbar vertebrae (L4-5) or between the 5th vertebra and the sacrum (L5-S1). Herniations occur less often at higher levels in the lumbar spine. Other less common causes are synovial cysts that arise from the facet joints and if they protrude into the spinal canal can compress a nerve root. Infections and tumors are very uncommon causes of nerve root compression. Spondylolisthesis (link) refers to a shift between two vertebrae which can result in narrowing of the foramen, which is the opening between the vertebrae where the nerve roots exit from the spine, causing compression of the nerve root. Spinal stenosis can result in severe leg pain but more often causes pain that is produced by activity such as walking.
In 80 to 90% of people the leg pain gradually gets better regardless of what a person does. It often takes 6 to 12 weeks for the pain to completely go away. In some people the pain goes away much sooner and in others it can take several months for the pain to resolve. In 10 to 20% of people the pain does not go away. If often improves to a certain degree and then remains the same. These people would potentially benefit from surgery to relieve the pressure on the nerve root. In some people activities associated with work, recreation or activities of daily living can aggravate the pain. In other people the pain remains the same regardless of their activity. Once the symptoms resolve they usually do not recur. The disc herniation can heal and recur in approximately 10 % of people. 90% of people do not have a recurrence and should be able to return to normal activity without developing pain.
Most disc herniations occur in people between 20 and 60 years of age. They can occur in teenagers but this is uncommon. After the age of 60 disc herniations are less common than lumbar spinal stenosis. In most people the discs become dehydrated as they age. This results in a decrease in the height of intervertebral discs which can lead to bulging of the outer annulus. This decease in disc height affects the associated lumbar facet joints and can lead to the progressive development of osteoarthritis. The occurrence of a disc herniation may accelerate this process.
CT scanning and MRI imaging are the two diagnostic procedures that are used to show the disc herniation or other cause of nerve root compression. This should be performed in people who would potentially benefit from surgery. Because most people get better without surgery, most people do not require any imaging studies. If the person has had previous lumbar spine surgery then MRI with contrast is the best test for identifying a new or recurrent disc herniation. EMG and NCS can identify which nerve is affected, especially if the person has any muscle weakness.
Because most disc herniations heal without surgery, non-operative treatment should be the first line of treatment. Physiotherapy, massage therapy and chiropractic treatment can benefit some people. Lumbar traction can also improve the sciatic leg pain. However in some people these forms of treatment can also aggravate the persons pain. Spinal decompression is a machine that applies repeated traction to the lower back is a non-operative approach that can help some people with disc herniations. However this treatment is not supported by any good scientific studies. People should remain as active as their pain permits. Injection of steroid medication into the spinal epidural space can significantly improve a persons pain by decreasing the inflammation which results from the disc herniation. This procedure is usually performed by anesthesiologists. Remaining active and continuing to work does not cause more damage and may not aggravate the pain. Bed rest, which was the most common recommended treatment in the past, does not relieve the pain or hasten a persons recovery. Prolonged bed rest can lead to loss of conditioning and make it more difficult for the person to return to their normal activity level once the pain resolves.
In the 10 to 20% of people whose pain does not go away after 6 to 12 weeks, surgery can relieve the pain. The most common operation for lumbar disc herniations is a microdiscectomy.
This involves a small incision in the back at the level of the affected disc. The piece of disc which is putting pressure on the nerve is identified and removed. Micro refers to the use of a microscope which provides better visibility and allows the operation to be done through a very small incision. Other surgical procedures include endoscopic discectomy and percutaneous discectomy which involve even smaller incisions but are less common. None of these procedures result in the removal of the whole disc. Usually only the small herniated fragment of disc material that is compressing the nerve is removed.
Results of surgery:
The success rate of microdiscectomy or similar surgical procedures is 80 to 90%. Most people have immediate relief of their leg pain. Numbness and weakness sometimes improve very quickly but sometimes take months to improve. In a small number of people the numbness and weakness may not improve even if the pain is relieved. In 5 – 10 % of people treated with surgery, which is approximately 1% of people who develop sciatica from disc herniations, pain can persist and become a chronic problem. This is due to damage to the nerve at the time of the original disc herniation. This is referred to as neuropathic pain and can be difficult to treat.
Possible complications of surgery: Infection, nerve injury, spinal fluid leak and instability are possible complications of the surgery. Most of them cause temporary symptoms but can lead to chronic back or leg pain.
Anatomy, Skin, Dermatomes Article
The skin is divided anatomically into distinct patterns based on the specific distribution of sensory nerve fibers arising from a single spinal nerve. These patterns were mapped and discussed most prominently in 1933 by O. Foerster in a publication entitled “The Dermatomes in Man” in the journal Brain, which some consider the founding basis on which dermatomal theory rests. After Foerster, J. Keegan and F. Garrett discussed the distribution of spinal nerves in 1948 in their publication “The Segmental Distribution of the Cutaneous Nerves in the Limbs of Man” in the journal The Anatomical Record. Most recently, in 2008, M. Lee, R. McPhee, and M. Stringer published an article in Clinical Anatomy entitled “An Evidence-Based Approach to Human Dermatomes,” in which they contested some of the classic presentations of dermatome maps and put forth an evidence-based method for determining a more accurate map of human dermatomes.
Structure and Function
Spinal nerves form from the dorsal nerve roots and the ventral nerve roots which branch from the dorsal and ventral horn of the spinal cord, respectively. The spinal nerves exit through the intervertebral foramina or neuroforamina and travel along their respective dermatomal distributions from posterior to anterior, creating the specific, observable dermatomal patterns.In total, there are 31 distinct spinal segments and thus 31 distinct spinal nerves bilaterally. These 31 spinal nerves are composed of 8 pairs of cervical nerves, 12 pairs of thoracic nerves, five pairs of lumbar nerves, five pairs of sacral nerves, and one pair of coccygeal nerve.
The cervical nerves C1-C7 exit through the intervertebral foramina above their respective vertebrae. Cervical nerve C8 exits between the C7 vertebra and the T1 vertebra. The remaining spinal nerves all exit below their respective vertebrae.
The dermatomes on the trunk are layered horizontally, one on top of the other. This horizontal pattern contrasts with the pattern on the extremities, where it is typically more longitudinal. This pattern is fairly standard although some variations can exist from person to person because spinal nerves overlap in the areas of the body they supply.
During embryological development, spinal nerves develop from neural crest tissue allowing for the formation of dermatomal, myotomal, and scleratomal patterns. The spinal cord begins development during the third week of the embryonic period with the formation of the neural plate and the elevation of the neural folds. Early in the fourth week of development, the neural folds begin to fuse. Late in the fourth week, neuroblasts form and move into the intermediate zone of the early neural tube, and this process continues throughout embryological development. During the sixth week, spinal nerves begin to form and progressively travel from dorsal to ventral.
Blood Supply and Lymphatics
The spinal cord and the spinal nerves receive their vascular supply predominantly via the anterior spinal artery and two posterior spinal arteries. The anterior spinal artery supplies the bulk of the spinal cord, the anterior two-thirds, while the two posterior spinal arteries supply the dorsal columns. These spinal arteries branch off the vertebral arteries in the skull and proceed out of the skull and course inferiorly along the spinal cord.
Several anatomic landmarks help easily identify or estimate different dermatomal levels.
- C6 – Thumb
- C7 – Middle finger
- C8 – Little finger
- T1 – Anteromedial forearm and arm
- T2 – Medial forearm and arm to the axilla
- T4 – Nipple
- T6 – Xyphoid process
- T10 – Umbilicus
- L3 – Medial knee
- L4 – Anterior knee and medial malleolus
- L5 – Dorsal surface of the foot and first, second, and third toes
- S1 – Lateral malleolus
Neurological evaluation of dermatomes helps to assess radiculopathy or neurologic deficits as radicular patterns can suggest specific spinal nerve involvement. For example, sciatica, a common condition with a lifetime prevalence reported as high as 84%, will often present along the dermatome of the involved spinal nerve. Sciatica-associated pain will commonly follow a path from the posterior hip down the back of the thigh to the knee involving the S1 or S2 dermatome. Neurological assessment of dermatomes helps to assess the level of spinal cord injury.
Herpes zoster infections, colloquially known as chickenpox and shingles, are caused by varicella zoster virus or human herpesvirus 3 (HHV-3). In the primary varicella infection, the distribution is widespread and diffuse, progressing in a cephalocaudal manner with classic lesions often described as “dew drops on a rose petal.” With the resolution of the primary infection, the virus retreats into the dorsal root ganglia awaiting reactivation. Viral reactivation can frequently be due to a triggering event while in an immunocompromised state, but immunosuppression is not requisite for reactivation of the virus and presentation of the secondary disease.
Once reactivated, the viral symptoms typically present in 3 different phases. The pre-eruptive, or prodromal, phase exhibits symptoms associated with sensory phenomena presenting along the affected dermatome. These sensory symptoms may present as pain, burning, itching, or paresthesias. After the pre-eruptive phase follows the eruptive phase during which the affected dermatome erupts in a grouped vesicular rash (herpetiform) on an erythematous base. The vesicular lesions will most commonly present along a truncal dermatome, with facial onvolvement the second most prevalent. The lesions progress through a pattern of vesicles, pustules, crusting, and resolution.
Disseminated herpes zoster is significantly rare and almost exclusively associated with severely immunocompromised states (i.e., AIDS, malignancy, long-term immunosuppressive therapy use, etc.). Affected patients are also at risk of life-threatening conditions including encephalitis or pneumonitis.
Of particular concern for herpes zoster infections is the involvement of the cranial nerves, particularly the trigeminal nerves (CN V). Herpes zoster ophthalmicus presents similarly to herpes zoster infections affecting the trunk, beginning with the prodromal phase of burning or itching on the skin, and can sometimes be clinically confused with trigeminal neuralgia while still in the pre-eruptive stage. The concern with herpes zoster ophthalmicus is that with the eruptive phase, lesions distribute along the face, and if involving the optic nerve, the oculomotor nerve, or the trigeminal nerve, blindness can result. Hutchinson’s sign, herpetic lesions along the lateral nose tip, indicates the involvement of the nasociliary branch of the first trigeminal nerve and is ominous of potential ocular involvement.
Upon resolution of the lesions, pain can remain and continue to affect patients along the affected dermatome as postherpetic neuralgia.
90,000 Treatment of radicular syndrome of the lumbosacral spine in Moscow in the Dikul clinic: prices, appointment
Lumbar radiculopathy (radicular syndrome) is a neurological condition caused by compression of one of the roots L1-S1, which is characterized by the presence of lower back pain radiating to the leg. Compression of the root can be manifested not only by pain (sometimes of a shooting nature), but also by impaired sensitivity by numbness, paresthesias or muscle weakness.Radiculopathy (radicular syndrome) can occur in any part of the spine, but it most often occurs in the lumbar spine. Lumbo-sacral radiculopathy occurs in about 3-5% of the population, both in men and women, but, as a rule, in men, the syndrome occurs at the age of 40, and in women, the syndrome develops between the ages of 50 and 60. Treatment of the radicular syndrome of the lumbosacral spine can be carried out using both conservative methods and using surgical techniques.
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 herniated disc or protrusion can put pressure on the nerve root and lead to inflammation in the root area.
- Degenerative disease of the joints of the spine resulting in the formation of bony spines at the facet joints, which can lead to narrowing of the intervertebral space, which will compress the nerve roots.
- Trauma or muscle spasm can put pressure on the root and cause symptoms in the innervation area.
- Degenerative disc disease, which leads to deterioration of the structure of the intervertebral discs, and a decrease in the height of the discs, which can lead to a decrease in free space in the intervertebral foramen and compression of the root at the exit of the spinal column.
- Spinal stenosis
- Infections or systemic diseases
In patients under 50 years of age, the most common cause of radicular syndrome in the lumbar spine is a herniated disc.After age 50, radicular pain is often caused by degenerative changes in the spine (stenosis of the intervertebral foramen).
Risk factors for the development of lumbar radiculopathy:
- age (45-64 years)
- mental stress
- Strenuous physical activity (frequent heavy lifting)
- Driving or vibration
Symptoms resulting from radicular syndrome (radiculopathy) are localized in the area of innervation of a particular root.
- Back pain radiating to the buttock, leg and extending down behind the knee, to the foot – the intensity of the pain depends on the root and the degree of compression.
- Violation of normal reflexes in the lower limb.
- Numbness or paresthesia (tingling) can occur from the lower back to the foot, depending on the area of innervation of the affected nerve root.
- Muscle weakness can occur in any muscle that is innervated by a pinched nerve root.Prolonged pressure on a nerve root can cause atrophy or loss of function in a particular muscle.
- Pain and local tenderness are localized at the level of the damaged root.
- Muscle spasm and postural changes in response to root compression.
- Pain increases with exertion and decreases after rest
- Loss of the ability to perform certain movements of the trunk: inability to straighten back, bend towards the localization of compression or stand for a long time.
- If the compression is significant, activities such as sitting, standing and walking may be difficult.
- Change in the normal lordosis of the lumbar spine.
- Development of stenosis-like symptoms.
- Joint stiffness after a period of rest.
- L1 – Back, front and inner thighs.
- L2 – back, front and inner thighs.
- L3 – posterior and anterior, and the inner surface of the thigh extending downward.
- L4 – back and front of the thigh, to the inner surface of the lower leg, to the foot and big toe.
- L5 – On the posterolateral part of the thigh, foreleg, upper part of the foot and middle toe
- S1 S2 – Buttock, back of the thigh and lower leg.
The onset of symptoms in patients with lumbosacral radiculopathy (radicular syndrome) is often sudden and includes low back pain.
Sitting, coughing, or sneezing can aggravate pain that spreads from the buttocks to the back of the lower leg, ankle, or foot.
Be alert for certain symptoms (red flags). These red flags may indicate a more serious condition that requires further evaluation and treatment (eg, tumor, infection). The presence of fever, weight loss, or chills requires careful evaluation.
The age of the patient is also a factor when looking for other possible causes of the patient’s symptoms.Individuals under 20 and over 50 are at increased risk of more serious causes of pain (eg, tumors, infections).
The primary diagnosis of lumbosacral spine radicular syndrome is made on the basis of symptoms of the medical history and physical examination data (including a thorough examination of the neurological status). Thorough analysis of motor, sensory and reflex functions can determine the level of nerve root damage.
If a patient reports typical unilateral radiating leg pain and there is one or more positive neurological test results, then the diagnosis of radiculopathy is very likely.
However, there are a number of conditions that can show similar symptoms. Differential diagnosis must be performed with the following conditions:
- Pseudoradical Syndrome
- Traumatic injuries of discs in the thoracic spine
- Injury to discs in the lumbosacral region
- Spinal stenosis
- Cauda equina
- Spinal tumors
- Spine infections
- Inflammatory / metabolic causes – diabetes, ankylosing spondylitis, Paget’s disease, arachnoiditis, sarcoidosis
- Trochanteric bursitis
- Intraspinal synovial cysts
To establish a clinically reliable diagnosis, as a rule, instrumental diagnostic methods are required:
- X-rays – can detect the presence of joint degeneration, fractures, bone defects, arthritis, tumors or infections.
- MRI is a valuable method of imaging morphological changes in soft tissues, including discs, spinal cord and nerve roots.
- CT (MSCT) provides comprehensive information on the morphology of the spinal bone structures and visualization of the spinal structures in cross section.
- EMG (ENMG) Electrodiagnostic (neurophysiological) studies are necessary to exclude other causes of sensory and motor disorders, such as peripheral neuropathy and motor neuron disease
Treatment of lumbosacral spine radicular syndrome will depend on the severity of symptoms and clinical manifestations.Most often, conservative treatment is used, but in certain cases, surgical treatment is necessary.
- Rest: Avoid activities that cause pain (bending, lifting, twisting, twisting or bending backwards. Rest is necessary for acute pain
- Drug treatment: anti-inflammatory, analgesic drugs, muscle relaxants.
- Physiotherapy. In case of acute pain syndrome, the use of such procedures as cryotherapy or hivamat is effective.Physical therapy can help reduce pain and inflammation of the spinal structures. After stopping the acute period, physiotherapy is carried out in courses (ultrasound, electrical stimulation, cold laser, etc.).
- Corsetting. The use of a corset is possible in case of acute pain syndrome to reduce the load on the nerve roots, facet joints, and lumbar muscles. But the duration of wearing the corset should be short, since prolonged fixation can lead to muscle atrophy.
- Epidural steroid or facet joint injections are used to reduce inflammation and relieve pain in severe radicular syndrome.
- Manual therapy. Manipulations improve the mobility of the motor segments of the lumbar spine and relieve excessive muscle tension. Using mobilization techniques also helps modulate pain.
Acupuncture. This method is widely used in the treatment of radicular syndrome in the lumbosacral spine and helps both to reduce symptoms in the acute period and is included in the rehabilitation complex.
- exercise therapy.Exercise includes stretching and muscle strengthening. The exercise program helps restore joint mobility, increase range of motion, and strengthen your back and abdominal muscles. A good muscle corset allows you to maintain, stabilize and reduce stress on the spinal joints, discs and reduce the compression effect on the root. The amount and intensity of exercise should be increased gradually in order to avoid recurrence of symptoms.
- In order to achieve a stable remission and restore the functionality of the spine and physical activity in full, it is necessary that the patient, after undergoing the course of treatment, continue independent studies aimed at stabilizing the spine. The exercise program should be individualized.
Operative methods of treatment of radicular syndrome in the lumbosacral spine are necessary in cases where there is resistance to conservative treatment or there are symptoms indicating severe compression of the root, such as:
- Increased radicular pain
- Signs of increased root irritation
- Weakness and muscle wasting
- Bowel and bladder incontinence or dysfunction
When symptoms increase, surgery may be indicated to relieve compression and remove degenerative tissue that affects the root.Surgical treatments for radicular syndrome in the lumbosacral spine will depend on which structure is causing the compression. Typically, these treatments include some way to decompress the root, or stabilize the spine.
Certain surgical procedures used to treat lumbar radiculopathy:
- Fixation of the vertebrae (spinal fusion – anterior and posterior)
- Lumbar laminectomy
- Lumbar microdiscectomy
- Transforaminal Lumbar Intercorporeal Fusion
- Cage implantation
- Deformation correction
In most cases, it is possible to treat radicular syndrome in the lumbosacral spine conservatively (without surgical intervention) and restore working capacity.The duration of treatment can vary from 4 to 12 weeks, depending on the severity of the symptoms. Patients should definitely continue to do exercises at home to improve posture, as well as stretch, strengthen and stabilize. These exercises are necessary to treat the condition that causes radicular syndrome.
Lumbosacral spine radicular syndrome can be prevented. To reduce the likelihood of developing this condition, you must:
- Practice good posture while sitting and standing, including while driving.
- Use correct body mechanics when lifting, pushing, extending, or performing any action that places additional stress on the spine.
- Maintain a healthy weight. This will reduce the stress on the spine.
- No smoking.
- Discuss your profession with an exercise therapy doctor who can analyze work movements and suggest measures to reduce the risk of injury.
- Muscles must be strong and flexible.Adequate levels of physical activity must be consistently maintained.
To prevent recurrence of lumbar radiculopathy, you must:
- Continue to use new habits, postures and movements that are recommended by the exercise therapy doctor.
- Continue with the home exercise program selected by the exercise therapy doctor.
- Continue to be physically active and in shape.
Back Surgery – HUG Neurosurgery Service in Geneva | HUG
Spine Surgery uses a multidisciplinary approach, carried out by an attending physician, rheumatologist, physiotherapist and interventional neuroradiologist.
The Spine Surgery Department has at its disposal technical means that allow performing neurosurgical operations with minimal intervention, namely: an endoscope, a video-guided system, intraoperative navigation, a robotic system and percutaneous instruments for performing spinal surgeries.
The spine consists of vertebrae and discs. The latter are pads located between the vertebrae, which serve as a shock absorber when moving.A herniated disc is a slipping of a part of an intervertebral disc towards the spinal canal, which contains the spinal cord and nerve roots. It most commonly occurs in the lower back and can cause compression and inflammation of the lumbar nerves. Although the disease is often asymptomatic, the nerve next to the disc may be compressed. This can lead to pain in the leg or hip, as well as loss of sensitivity and weakness, and sometimes develop into paralysis.Surgical treatment is used in very specific cases after complete diagnosis and ineffective conservative treatment (drugs, physiotherapy).
Stenosis of the spinal canal in the lumbar spine
Refers to the narrowing of the cavity located in the center of the lumbar vertebrae (spinal canal) and compression of the nerve roots located in it, which causes pain in the lower back and lower extremities. Surgical treatment consists of minimally invasive decompression of the canal to relieve pressure on the nerves and reduce pain.
Stenosis of the spinal canal in the cervical spine
When the spinal canal at the level of the cervical spine is compressed, the spinal cord can become compressed. This pathological condition is accompanied by a feeling of creeping in the upper limbs, imbalance and gait, or urinary and fecal incontinence. In such cases, after an extended diagnosis, surgical treatment is prescribed in order to free the spinal cord in the cervical spine.
Spinal tumors and bone metastases
Neurosurgery deals with the treatment of tumors of the spinal cord (ependymoma, glioma), nerve roots (schwannoma) and the meninges (meningioma).
Affected vertebrae (bone tumors or metastases) are also subject to treatment. Various multidisciplinary seminars are held every week to discuss such cases and choose the most optimal treatment method.
Fusion is an approach that involves bringing two or more vertebrae closer together using screws and fixing rods.It is used to limit vertebral pain and to keep the spine in the correct position. This method is used for spinal instability, sagittal balance disorders or fractures.
There are many techniques for performing fusion, and your surgeon will tell you in detail which one is best for your case.
Inflammation of the sciatic nerve | EMC
The European Clinic for Sports Traumatology and Orthopedics (ECSTO) diagnoses and treats diseases of the musculoskeletal system, which include inflammation of the sciatic nerve.Qualified medical care at the ECSTO clinic meets world standards thanks to modern equipment, the latest medical advances and a close-knit team of like-minded people. By contacting the ECSTO clinic, you can be sure that everything possible will be done to achieve the best results.
Among the complaints with which patients often turn to us, one can often hear about inflammation of the sciatic nerve, better known in the medical world as sciatica. According to various sources, this disease develops in 13-40 people out of 100.Typical symptoms are pain of varying severity along the back of the leg from the buttock and below, often worsening when bending forward or when lifting the straight leg up from a prone position. Often, the pain worsens while sitting with pressure on the buttock of the affected side. Morning worsening of symptoms is also characteristic of this disease. The pain can be pronounced and cause restrictions and discomfort in everyday life: the inability to sit, drive a car, walk, play sports, and others.
In milder forms of sciatica, there is a chance of spontaneous recovery, but the risk of the disease becoming chronic is quite high. At the time of the onset of the disease, it is impossible to predict the course of the disease, therefore, a thorough examination and treatment is necessary at the earliest possible stages.
herniated disc (one of the most common causes of sciatica).
narrowing of the intervertebral foramen in osteochondrosis, resulting in compression of the nerve roots and inflammation of the sciatic nerve;
hypothermia of the body;
injuries of the musculoskeletal system;
infections in the pelvic region.
Note that sciatica during pregnancy is a frequent occurrence, because due to complex changes in posture and mechanics of movements of the spinal column, the transverse dimensions of the intervertebral foramen decrease, which leads to compression of the nerve roots.
The diagnosis is made on the basis of data obtained during a comprehensive examination under the guidance of a neurologist. The specialist will prescribe all the necessary instrumental examinations (X-ray of the spinal column and MRI of the lumbar spine), as well as, if necessary, involve specialists of related specialties for further examination and treatment of sciatica – a rehabilitation therapist, chiropractor, neurosurgeon.
Treatment of sciatic nerve inflammation
The course of treatment is selected depending on the cause and stage of the disease. In the overwhelming majority of cases, conservative treatment is carried out, including taking medications and carrying out physiotherapy procedures, massage, gymnastics and manual therapy.
If pain persists despite treatment, minimally invasive surgery is performed to address the cause of sciatica, such as herniated disc.Note that surgical treatment is indicated only as a last resort.
The European Clinic of Sports Traumatology and Orthopedics diagnoses and treats diseases of the musculoskeletal system using modern equipment and advanced treatment methods. The qualified specialists of the ECSTO clinic will do their best to achieve positive results in the treatment.
Turning to our clinic, you can be sure that you will be consulted by an experienced doctor dealing with the treatment of this pathology.In addition, you will be able to take a course of conservative therapy in one of the most modern departments of rehabilitation therapy in Russia.
90,000 symptoms, signs and causes, diagnosis and treatment
When the sciatic nerve is pinched, the pain is acute, it is impossible to move, severe muscle spasms force the patient to be in complete rest, depriving him of the opportunity to actively live. According to statistics, about 40% of people have experienced this pathology.
Pinching of the sciatic nerve (sciatica) is a neurological disease in which compression of the nerve roots or the nerve itself occurs, followed by inflammation, at the level of the lumbar spine, gluteal region, and the back of the thigh.
The sciatic nerve, formed from two lumbar and three sacral spinal nerves, is the largest in the human body. Innervates the gluteal region and the entire lower limb. It originates from the thigh and ends with the toes.
Inflammation of the sciatic nerve occurs not only due to its compression, but banal hypothermia can provoke the disease.
The main causes of pinching of the sciatic nerve.
- Protrusion and hernia of the intervertebral (intervertebral) disc.Sciatica is determined in 70% of patients with hernia. But it is wrong to think that if there is a hernia, then there will certainly be a pinching of the sciatic nerve.
- Osteochondrosis of the lumbar spine.
- Various tumors in the lumbar region.
- Injuries to the spine and surrounding muscles.
- Spasmodic piriformis muscle.
- Infectious and inflammatory processes in the body.
Clinical symptoms of sciatica.
- Pain in the lumbar region, buttock. The nature of the pain is burning, sudden, shooting. It intensifies with physical exertion, a long standing position, radiates to the lower limb.
- Lameness, decreased mobility in the joint.
- Fatigue and general malaise.
- Tingling, goose bumps, coldness or heat in the lumbar region, buttock or lower limb.
Pinching of the sciatic nerve is a consequence of a serious pathology and before starting treatment it is necessary to find out the cause that led to the development of the disease.
Manual therapy for sciatica is an effective method of treatment if the cause of the development of pathology is protrusion, osteochondrosis and hernia of the lumbar spine, impaired mobility of the joints, muscle strain and tissue edema, leading to compression of the sciatic nerve.
Manual therapy for pinched sciatic nerve, thanks to specific techniques and gentle techniques, will eliminate the cause of pinched sciatic nerve by restoring the vertebrae to their physiological place.
The methods of manual therapy allow you to gently and gently eliminate nerve compression and pain, restore normal tone to muscles and ligaments, relieve swelling, and restore lost mobility. Sometimes a massage session is needed, which is carried out along with manual therapy.
Manual therapy for pinching of the sciatic nerve is carried out only after a thorough diagnostic examination. Careful examination of the patient, anamnesis of the disease, analysis of laboratory and instrumental examination (X-ray or MRI, ultrasound, electromyography, etc.)enables the chiropractor to select an individual therapy technique for each individual patient.
During a manual therapy session, with the appearance of increasing pain or other undesirable sensations, the doctor strictly controls the process and can change the tactics and technique of the procedure.
In our clinic you will receive a full range of services for manual therapy. High-level specialists with a higher medical education, significant experience in manual therapy and who love their job will work with you.
Manual therapy for pinching the sciatic nerve, patient reviews of the Freedom of Movement clinic:
Entrust your health to professionals, make an appointment by phone: +7 (495) 212-08-81.
We are waiting for you at the address: SZAO, Moscow, Kurkinskoe shosse, 30
Our clinic is open from 9:00 to 21:00 seven days a week.
90,000 Treatment of radicular syndrome in Yekaterinburg
Radicular or radicular syndrome
This is a complex of clinical manifestations caused by compression of the spinal nerve roots.Sometimes radicular syndrome is called radiculitis, but with this disease there is often no inflammatory process, so radiculopathy is correct.
Degenerative diseases of the spine (the most common causes): osteochondrosis (protrusion, herniated discs), spondyloarthrosis (arthrosis of the intervertebral joints), spondylolisthesis, spondylolysis (displacement of the vertebrae). Compression or comminuted fractures of the vertebrae or other bone structures against the background of osteoporosis, cancer, tumors of soft tissues and bone structures (spondylitis, rheumatitis).
A bit of anatomy
Depending on the level of localization of the hernia, pain can occur in the upper or lower extremities, accompanied by numbness, tingling, burning, and movement disorders. As a result, a violation of sleep and work.
Early diagnosis of herniated disc can significantly reduce the time of further treatment. After consulting a doctor, an MRI (magnetic resonance imaging) or CT (computed tomography) scan is usually prescribed, which allows you to see the pathology in a section, to identify the location and extent of the lesion.
The spinal cord is 31-32 segments, where each corresponds to 2 pairs of roots: anterior (sensory) and posterior (motor):
- Cervical – 8 segments (CI-CVIII)
- Chest – 12 segments (ThI-ThXII)
- Lumbar region – 5 segments (LI-LV)
- Sacral region – 5 segments (SI-SV)
All roots inside the spinal canal are collected in one common bundle.radicular nerve (it is located and leaves the intervertebral foramen on the right and left).
Each segment is responsible for the sensitive innervation (a certain part of the skin and motor innervation (certain muscles) Segments CI-CIII only the sensitive innervation of the skin of the occiput of the parotid region, the back of the neck.
Pulling, shooting, burning pain in the nerve root zone. In the vertebral part of the neck with irradiation to the upper part. In the thoracic spine with irradiation along the intercostal spaces.In the lumbar region with irradiation to the lower extremities. Movement disorders: muscle weakness (paresis) corresponding to the root. In the cervical region, weakness in the upper limbs, in the lumbar region, weakness in the lower limbs.
With prolonged course of muscle wasting and atrophy (decrease in muscle volume, change in shape and structure).
Dysfunction of the pelvis (only in case of complications of spinal stenosis and compression of the spinal cord)
Diagnostics: consultation of a vertebral neurologist
X-ray of the lumbar or cervical spine in 2 projections (to exclude vertebral fractures), functional tests (to exclude displacement of the vertebrae) MRI (CT) of the cervical, thoracic and lumbar spine electromyography of the upper and lower extremities
- 1.Pain relief
- 2. Improvement of blood supply
- 3. Metabolic therapy
- 4. Anticholinesterase drugs, improve conductivity and increase muscle strength
- 5. Antibacterial drugs (only in case of inflammatory process)
- 6. Chondroprotectors
Removal of the cause of compression of the radicular nerve (removal of the tumor, disc herniation)
All treatments are aimed at improving blood circulation, relieving muscle spasms, restoring sensitivity and restoring muscle strength.
- Physiotherapy (Magnetic laser, magnetotherapy, SMT with novocaine, SMT in electrostimulation mode, ultrasound with hydrocortisone, etc.)
- Apparatus traction of the cervical and lumbar spine
- Back and limb massage
- Manual therapy
- exercise therapy
- Balneotherapy (radon baths, mud applications, ozokerite)
Payment methods: cash payment; payment by plastic bank cards MIR, VISA, Mastercard Worldwide
Stimulation of the spinal cord and peripheral nerves (SCS, PNS)
The technique is used to treat various kinds of pathological conditions accompanied by severe pain in the legs, back, perineum, spasticity in the lower extremities.Also used for the treatment of erectile dysfunction, dysfunction of the pelvic organs. The technique consists in placing electrodes on the surface of the spinal cord, to which stimuli are supplied from a stimulator inserted under the skin. Before the final implantation of the stimulator, a test stimulation is carried out, when the electrodes are brought out and connected to an external stimulator, to select the stimulation parameters, to assess the effectiveness in each case.
Method of treatment of chronic pain syndrome, spasticity, dysfunction of the pelvic organs.
The effect is achieved using electrical impulses that are delivered by electrodes implanted in the epidural space.
The electrodes are connected to a neurostimulator, which is implanted subcutaneously.
Today, conservative treatment methods do not always provide sufficient pain relief.
Neurostimulation is an alternative method of treating patients with NB, if traditional conservative methods of treatment do not bring the desired result.
TEST NEUROSTIMULATION (TN)
TH assumes the implantation of an electrode, which is part of the test system. The electrode is inserted under local anesthesia. Thanks to TH, it is possible to obtain an analgesic (pain-relieving) effect already on the operating table, as well as more likely to predict the effectiveness of neurostimulation even before the entire system is implanted.
The test period for 7-10 days is carried out on an outpatient basis, close to everyday ones, in order to better assess the dynamics of pain syndrome and its effect on daily activity.In the test period, the selection of the optimal parameters of electrical stimulation is carried out.
If, according to the results of TN, it was possible to achieve a 50% reduction in pain according to the Visual Analogue Scale (a scale for assessing the intensity of pain), then the patient can be fully implanted with the neurostimulation system. In case of failure, the question will arise about the transition to the next step.
Separately, it should be noted that for some pain syndromes, for example, with traumatic tearing of the nerve plexus roots, patients undergo surgical interventions, for example, a DREZ operation.With a herniated disc, an appropriate excision of the hernia. And for cancer pain – chordotomy.
Prerequisite: Before installing the neurostimulating system, a test stimulation is performed (see above), which allows the doctor to verify the effectiveness of the technique.
MEDTRONIC SCS COMPONENTS
The non-neurostimulation system consists of three basic implantable components that can be used unilaterally or bilaterally:
The non-neurostimulation system consists of three basic implantable components that can be used unilaterally or bilaterally:
- Extension cable;
- Percutaneous cylindrical or surgical electrode.
Neurostimulator, or implantable pulse generator.
A neurostimulator is an isolated device, similar to a pacemaker, consisting of a battery and electronics. It is implanted subcutaneously and generates the electrical impulses required for unilateral or bilateral stimulation. These impulses are carried along extension cords and electrodes to the spinal cord.
The extension cord is a thin insulated wire.Extension cords are implanted subcutaneously by connecting an electrode to a neurostimulator.
The electrode is a thin insulated four-core wire with four, eight or 16 pins at the tip. An electrode is implanted in the epidural space to conduct electrical current there, which initiates neurostimulation. The optimal position of the electrode is always in correlation with the patient’s pain zone. To stimulate the spinal cord, electrodes are implanted in the epidural space (between the vertebra with the dura mater), with the electrode contacts close enough to the dorsal horn of the spinal cord to stimulate thick myelinated nerve fibers.
Non-implantable system components
Non-implantable system components include the Patient Console and Physician Programmer, which are used to control the neurostimulator.
N’Vision doctor’s programmer. Used to program neurostimulators. The parameters of the impulses generated by the neurostimulator can be non-invasively changed using the doctor’s programmer. The programmer transmits the settings to the neurostimulator remotely using radio frequency communication.
Patient console. The patient console is a portable device that allows the patient to turn the neurostimulator on and off when needed, and check the neurostimulator’s battery level.
Benefits of SCS spinal cord stimulation include:
Optimal treatment of sciatic nerve and sciatica
Injury to the sciatic nerve often causes severe, sudden pain that can radiate from the lower back to the buttocks and thighs, and even to the feet.This extremely unpleasant phenomenon has many names: pinching of the sciatic nerve, sciatica, irritation of the sciatic nerve, lumbago.
What is the sciatic nerve and what is its function?
The sciatic nerve is the largest nerve in the human body. It performs a central function: it transmits all the commands of the brain through the spinal cord to the muscles of the lower extremities. It consists of many roots that diverge from the spinal cord at different heights.
In the hip region, it extends outward and extends from the outside of the thigh to the patella.There, it splits into the peroneal and tibial nerves, which continue to the foot, causing problems with the sciatic nerve to cause widespread pain that is felt from the last lumbar vertebra to the feet. Pain occurs due to irritation of the nerve, which occurs as a result of pressure, pinching or inflammation. They can be caused by various reasons. In medicine, this phenomenon is called sciatica.
Why does pain occur?
Pain associated with the sciatic nerve can have a variety of origins.There are two main reasons: nerve damage and inflammation.
Sciatic nerve injuries occur for the following reasons:
The most common cause of sciatica is a herniated disc. Due to the displacement of the disc, pressure arises on the nerve, as a result of which it is pinched. More about herniated discs
If the sciatic nerve is pinched by the piriformis muscle, piriformis syndrome develops. It is caused by unilateral overloading as a result of improper bending of the back.
Accidents, tumors, metastases, edema, abscesses, surgery and bleeding can also be risk factors for sciatica. External pressure builds up on the nerve, resulting in pinching and pain. Childbirth can also cause sciatica because the baby’s head is close to the nerve course during labor.
Pain associated with the sciatic nerve can also be caused by structural changes. For example, avid runners develop poor posture due to muscle contraction while running, which over time can lead to a pinched nerve.Another cause of these symptoms may be degenerative changes in the spine.
Overweight and diabetes mellitus are also factors contributing to the development of sciatica.
Inflammation of the sciatic nerve can be caused by the following factors:
- Lyme disease: An infectious disease carried by ticks can, among other things, cause painful inflammation of the nerve roots.
- Shingles: This viral disease can affect the sciatic nerve roots and subsequently lead to severe pain.
What are the symptoms of sciatica?
Because of the fairly straightforward symptoms, the diagnosis of sciatica is usually quite simple. It is more difficult to find the cause – what caused the pain from the sciatic nerve? Further examinations may be ordered depending on the complexity.
Pain can be of varying intensity depending on the site of nerve irritation. Often these are pains of a pulling nature on the back of the thigh, which in the morning, after a long sleep, are felt most strongly, and after movement they can let go for a while.Also, a fairly common symptom is pinpoint pain in the buttocks, combined with induration in this place. Sciatica can also manifest itself as sudden shooting pains, which are often confused with lumbago (but, unlike lumbago, in sciatica, pain radiates to the legs).
What treatment options are there for sciatica?
In case of sciatic nerve inflammation, the underlying disease must be cured. Different remedies are used depending on the severity of the symptoms. In milder cases, the pain can be relieved by laying down in a position that relieves the spine, on a special orthopedic device with leg support, as well as various thermal procedures.Regular movement and proper stress distribution in daily life also contribute to recovery.
But even in severe cases, surgery is not always required. For sciatica, various pain relievers are often prescribed in combination with physical therapy: exercises, massages, relaxation exercises, and various movement exercises. Quite often, this combined approach resolves the symptoms.
Experienced partner in the treatment of sciatica
At the Johannesbad Clinic in Bad Füssing, we offer a comprehensive treatment for sciatica .We guarantee a completely individual approach. For this, we have developed an optimal treatment program with the participation of physiotherapists and osteopaths AGAIN IN FORM.
The program is drawn up after detailed individual consultations and thorough diagnostics. It includes all the necessary examinations, 3-D spine measurements, a stress management program and daily intensive treatment with a personal trainer – an experienced physiotherapist with a variety of required qualifications.
Mon-Fri from 7:00 am to 4:30 pm