What are dermatomes. How are dermatomes mapped. Why are dermatomes important in clinical practice. What techniques are used for dermatome testing. How do dermatomes relate to spinal nerve roots. What controversies exist in dermatome mapping. How can dermatome knowledge improve patient care.

The Fundamentals of Dermatomes: Defining Skin Innervation Patterns

Dermatomes are specific areas of skin innervated by sensory nerve fibers originating from a single spinal nerve root. The term “dermatome” combines two Greek words: “derma” (skin) and “tome” (cutting or thin segment). This concept is crucial for understanding the relationship between the nervous system and skin sensation.

There are 30 dermatomes in total, corresponding to the following spinal nerve roots:

• 8 cervical nerves (C1-C8, with C1 having no dermatome)
• 12 thoracic nerves (T1-T12)
• 5 lumbar nerves (L1-L5)
• 5 sacral nerves (S1-S5)

Each dermatome relays sensation from a particular region of the skin to the brain. Understanding these patterns is essential for diagnosing and treating various neurological conditions.

The Evolution of Dermatome Mapping: Historical Perspective

The concept of dermatomes has evolved significantly since its inception. Early efforts to associate anatomy with sensory physiology led to the development of dermatome maps. Two primary maps have been widely recognized in the medical profession:

1. The Keegan and Garret Map (1948): This map aligns dermatomes with the developmental progression of limb segments.
2. The Foerster Map (1933): This map depicts the medial area of the upper limb as innervated by T1-T3, illustrating pain distribution from angina or myocardial infarction. It is the most commonly used map in healthcare and forms the basis for the American Spinal Cord Injury Association (ASIA) Impairment Scale.

In recent years, researchers have attempted to verify and refine these original dermatome maps. Lee et al. conducted a comprehensive review of dermatome map discrepancies and proposed an “evidence-based” map that combines elements from previous versions.

Clinical Relevance: How Dermatome Knowledge Enhances Patient Care

Understanding dermatomes is crucial for healthcare professionals, as it aids in diagnosing and localizing various neurological conditions. How does dermatome knowledge improve patient care? Consider the following applications:

• Identifying radiculopathies: By assessing sensory loss in specific dermatomes, clinicians can pinpoint which spinal nerve root is affected.
• Determining spinal cord injury levels: Dermatome mapping helps assign neurological levels to spinal cord lesions.
• Diagnosing referred pain: Knowledge of dermatomes aids in understanding pain patterns that may originate from internal organs.
• Guiding treatment approaches: Accurate dermatome assessment can inform targeted interventions, such as nerve blocks or surgical procedures.

By incorporating dermatome knowledge into clinical practice, healthcare providers can enhance their diagnostic accuracy and develop more effective treatment strategies.

Dermatome Testing Techniques: Assessing Sensory Function

How are dermatomes tested in clinical settings? Dermatome testing is an integral part of the neurological examination. The primary goal is to assess sensory function in specific skin areas corresponding to individual spinal nerve roots. Here’s an overview of the testing process:

1. Patient preparation: Ask the patient to close their eyes to eliminate visual cues.
2. Sensory stimulation: Use a pin for sharp sensation and cotton wool for light touch.
3. Systematic approach: Test each dermatome systematically, comparing sides for symmetry.
4. Patient feedback: Ask the patient to provide feedback on their sensations during the examination.
5. Documentation: Record any areas of altered sensation, noting the specific dermatomes involved.

By carefully performing dermatome testing, clinicians can gather valuable information about a patient’s neurological status and identify potential nerve root or spinal cord involvement.

Dermatome Distribution: A Comprehensive Overview

Understanding the specific distribution of dermatomes is essential for accurate clinical assessment. Here’s a detailed breakdown of dermatome innervation patterns:

Cervical Dermatomes (C2-C8)

• C2: Temple, forehead, occiput
• C3: Entire neck, posterior cheek, temporal area
• C4: Shoulder area, clavicular area, upper scapular area
• C5: Deltoid area, anterior aspect of entire arm to base of thumb
• C6: Anterior arm, radial side of hand to thumb and index finger
• C7: Lateral arm and forearm to index, long, and ring fingers
• C8: Medial arm and forearm to long, ring, and little fingers

Thoracic Dermatomes (T1-T12)

• T1: Medial side of forearm to base of little finger
• T2: Medial side of upper arm to medial elbow, pectoral and midscapular areas
• T3-T6: Upper thorax
• T5-T7: Costal margin
• T8-T12: Abdomen and lumbar region

Lumbar Dermatomes (L1-L5)

• L1: Back, over trochanter and groin
• L2: Back, front of thigh to knee
• L3: Back, upper buttock, anterior thigh and knee, medial lower leg
• L4: Medial buttock, lateral thigh, medial leg, dorsum of foot, big toe
• L5: Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes

Sacral Dermatomes (S1-S4)

• S1: Buttock, thigh, and leg posterior
• S2: Same as S1
• S3: Groin, medial thigh to knee
• S4: Perineum, genitals, lower sacrum

The coccygeal dermatome is located on the buttocks, in the area directly around the coccyx.

Controversies in Dermatome Mapping: Challenges and Limitations

Despite the widespread use of dermatome maps in clinical practice, several controversies and limitations exist. What are the main challenges in dermatome mapping? Consider the following issues:

• Individual variation: Dermatome patterns can vary significantly between individuals, making standardized maps less reliable.
• Overlap between adjacent dermatomes: Sensory innervation often overlaps between neighboring dermatomes, complicating precise mapping.
• Inaccuracies in historical studies: Some evidence suggests that current dermatome maps may be based on flawed or outdated studies.
• Lack of recent verification: Few attempts have been made to verify original dermatome maps using modern research methods.
• Discrepancies between maps: Different dermatome maps may show conflicting innervation patterns for certain body regions.

These controversies highlight the need for continued research and refinement of dermatome mapping techniques to improve their clinical utility and accuracy.

Dermatomes and Spinal Nerve Roots: Unraveling the Connection

The relationship between dermatomes and spinal nerve roots is fundamental to understanding sensory innervation patterns. How do spinal nerve roots relate to dermatomes? Let’s explore this connection:

• Spinal nerve formation: Spinal nerves are formed by the combination of dorsal (sensory) and ventral (motor) nerve roots.
• Dorsal root ganglion: Sensory neurons for each dermatome have their cell bodies located in the dorsal root ganglion of the corresponding spinal nerve.
• Peripheral nerve composition: Many peripheral nerves are formed by the intermingling of multiple spinal nerve roots in a plexus (e.g., brachial, lumbar, or lumbosacral).
• Overlapping innervation: A single peripheral nerve may receive contributions from multiple spinal nerve roots, resulting in overlapping dermatome patterns.
• Clinical implications: Dysfunction or damage to a specific spinal nerve root can lead to sensory disturbances in the corresponding dermatome.

Understanding this relationship is crucial for accurately interpreting dermatome patterns and diagnosing neurological conditions affecting spinal nerve roots.

Applying Dermatome Knowledge in Clinical Practice: Case Studies and Examples

To illustrate the practical application of dermatome knowledge, let’s examine some common clinical scenarios:

Case 1: Cervical Radiculopathy

A 45-year-old patient presents with tingling and numbness in the thumb and index finger of the right hand. Based on dermatome mapping, which spinal nerve root is likely affected?

Answer: The C6 nerve root is the most likely culprit, as it innervates the thumb and index finger. Further examination of muscle strength and reflexes in the C6 distribution would help confirm this diagnosis.

Case 2: Lumbar Disc Herniation

A 32-year-old patient complains of pain radiating down the lateral aspect of the right leg to the dorsum of the foot. Which dermatome is primarily involved?

Answer: The L5 dermatome is the primary area affected in this case. This pattern of pain distribution suggests a possible L5 nerve root compression, potentially due to a herniated disc at the L4-L5 level.

Case 3: Thoracic Spinal Cord Injury

A patient with a thoracic spinal cord injury reports loss of sensation below the nipple line. Which dermatome level corresponds to this sensory loss?

Answer: The nipple line generally corresponds to the T4 dermatome. A sensory level at this point suggests a spinal cord injury at or above the T4 vertebral level.

These case studies demonstrate how dermatome knowledge can guide clinical reasoning and help localize neurological lesions accurately.

Future Directions in Dermatome Research: Advancing Our Understanding

As our understanding of neuroanatomy and sensory innervation patterns evolves, what are the potential future directions for dermatome research? Consider the following areas of investigation:

• Advanced imaging techniques: Utilizing high-resolution MRI and functional neuroimaging to map dermatomes more precisely.
• Genetic studies: Investigating the genetic factors that influence dermatome development and individual variation.
• Quantitative sensory testing: Developing more sophisticated methods for assessing sensory function within dermatomes.
• Computational modeling: Creating detailed 3D models of dermatome patterns to account for individual variations and overlapping innervation.
• Clinical correlation studies: Conducting large-scale studies to correlate dermatome patterns with specific neurological conditions and treatment outcomes.

By pursuing these research avenues, we can refine our understanding of dermatomes and enhance their clinical utility in diagnosing and treating neurological disorders.

As we continue to explore the complexities of dermatomes and their clinical applications, it’s clear that this field holds immense potential for improving patient care and advancing our understanding of the nervous system. By integrating dermatome knowledge with emerging technologies and research methodologies, healthcare professionals can develop more accurate diagnostic tools and targeted treatment strategies for a wide range of neurological conditions.

Dermatomes – Physiopedia

Original Editor – Lucinda Hampton

Top Contributors –

Naomi O’Reilly,

Anas Mohamed,

Lucinda hampton,

Joao Costa,

Nikhil Benhur Abburi,

Rachael Lowe,

Kim Jackson and

Blessed Denzel Vhudzijena

Lead Editors  

Contents

• 1 Dermatomes
• 2 History
• 3 Purpose
• 4 Technique
• 5 Controversies
• 6 Clinical Significance
• 7 References

The term “dermatome” is a combination of two Greek words; “derma” meaning “skin”, and “tome”, meaning “cutting” or “thin segment”. Dermatomes are areas of the skin whose sensory distribution is innervated by the afferent nerve fibres from the dorsal root of a specific single spinal nerve root, which is that portion of a peripheral nerve that “connects” the nerve to the spinal cord.

Nerve roots arise from each level of the spinal cord (e. g., C3, C4), and many, but not all, intermingle in a plexus (brachial, lumbar, or lumbosacral) to form different peripheral nerves as discussed above. This arrangement can result in a single nerve root supplying more than one peripheral nerve. For example, the median nerve is derived from the C6, C7, C8, and T1 Nerve Roots, whereas the ulnar nerve is derived from C7, C8, and T1.

In total there are 30 dermatomes that relay sensation from a particular region of the skin to the brain – 8 cervical nerves (note C1 has no corresponding dermatomal area), 12 thoracic nerves, 5 lumbar nerves and 5 sacral nerves. Each of these spinal nerves roots.^[1] Dysfunction or damage to a spinal nerve root from infection, compression, or traumatic injury can trigger symptoms in the corresponding dermatome. ^[2]

^[3]

Table. 1 Dermatomes

Nerve Root			Dermatome
Cervical	C2	Supply Skin of Neck	Temple, Forehead, Occiput
	C3		Entire Neck, Posterior Cheek, Temporal Area, Prolongation forward under Mandible
	C4		Shoulder Area, Clavicular Area, Upper Scapular Area
	C5	Supply the Arms	Deltoid Area, Anterior aspect of entire arm to base of thumb
	C6		Anterior Arm, Radial side of hand to thumb and index finger
	C7		Lateral Arm and Forearm to index, long, and ring fingers
	C8		Medial Arm and forearm to long, ring, and little fingers
Thoracic	T1		Medial side of forearm to base of little finger
	T2	Supply the chest and abdomen	Medial side of upper arm to medial elbow, pectoral and midscapular areas
	T3 – 6		Upper Thorax
	T5 – 7		Costal Margin
	T8 – 12		Abdomen and Lumbar Region
Lumbar	L1		Back, over trochanter and groin
	L2		Back, front of thigh to knee
	L3	Supply Skin of Legs	Back, upper buttock, anterior thigh and knee, medial lower leg
	L4		Medial buttock, latera thigh, medial leg, dorsum of foot, big toe
	L5		Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes
Sacral	S1		Buttock, Thigh, and Leg Posterior
	S2	Supply Groin	Same as S1
	S3		Groin, medial thigh to knee
	S4		Perineum, genitals, lower sacrum
Coccygeal	The dermatome corresponding with the coccygeal nerves is located on the buttocks, in the area directly around the coccyx. [4][5]

The idea of dermatomes originated from initial efforts to associate anatomy with the physiology of sensation. Multiple definitions of dermatomes exist, and several maps are commonly employed. Although they are valuable, dermatomes vary significantly between maps and even among individuals,^[6] with some evidence suggesting that current dermatome maps are inaccurate and based on flawed studies.^[7][8]

The medical profession typically recognised two primary maps of dermatomes. Firstly, the Keegan and Garret Map (Fig.1) from 1948, which illustrates dermatomes in alignment with the developmental progression of the limb segments. Secondly, the Foerster Map from 1933, which portrays the medial area of the upper limb as being innervated by T1-T3, depicting the pain distribution from angina or myocardial infarction. This latter map is the most frequently used in healthcare and accounts for the dermatomes used in the American Spinal Cord Injury Association Impairment Scale (ASIA Scale). In recent years there have been few attempts at verifying these original dermatome maps. Lee et al conducted an in-depth review that examined the discrepancies among dermatome maps. They put forth an “evidence-based” dermatome map that combined elements of previous maps (Fig.3). Though the application of the term “evidence-based” may be somewhat questionable, their proposed map represents a systematic attempt to synthesise the most credible evidence available.^[6][7]

Testing of dermatomes is part of the neurological examination. They are primarily used to determine whether the sensory loss on a limb corresponds to a single spinal segment, implying the lesion is of that nerve root (i.e., radiculopathy), and to assign the neurologic “level” to a spinal cord lesion^[9].

Dermatome Testing is done ideally with a pin and cotton wool. Ask the patient to close their eyes and give the therapist feedback regarding the various stimuli. Testing should be done on specific dermatomes and should be compared to bilaterally.

• Light Touch Test – Light Touch Sensation – Dab a piece of cotton wool on an area of skin ^[10]
• Pinprick Test – Pain Sensation – Gently touches the skin with the pin ask the patient whether it feels sharp or blunt

During the review of systems, asking the patient to carefully describe the pattern or distribution of sensory symptoms (e.g., tingling, numbness, diminished, or absent sensation) provides the therapist with preliminary information to help guide the examination and to assist in identifying the dermatome(s) and nerve(s) involved.^[11]

Light touch dermatomes are larger than pain dermatomes. When only one or two segments are affected, testing for pain sensibility is a more sensitive method of examination than testing for light touch.^[9]

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. There exist some discrepancies among published dermatome maps based on the methodologies used to identify skin segment innervation.

In a clinical commentary, Downs and Laporte discuss the history of dermatome mapping, including the variations in methodologies employed, and the inconsistencies in the dermatome maps used in education and practice.^[11] [[Laporte C. Conflicting dermatome maps: educational and clinical implications. journal of orthopaedic & sports physical therapy. 2011 Jun;41(6):42^[12]7-34.]]

Dermatomes are important because they can help to assess and diagnose a variety of conditions. Neurological screening of dermatomes helps to assess patterns of sensory loss that can suggest specific spinal nerve involvement. For instance, symptoms that occur along a specific dermatome may indicate disruption or damage to a specific nerve root in the spine.

• Nerve Entrapment
• Radiculopathy
• Spinal Cord Injury
• Herpes Zoster ^[2]

1. ↑ Wikipedia Dermatome. Available from: https://en.wikipedia.org/wiki/Dermatome_(anatomy) (last accessed 23.4.2019)
2. ↑ ^2.02.1 Medical news today What and where are dermatomes? Available:https://www.medicalnewstoday.com/articles/what-are-dermatomes (accessed 25.5.2022)
3. ↑ M Roehrs. Dermatomes. Available from: https://www.youtube.com/watch?v=CYZBH6NX8wg&feature=youtu.be (last accessed 23.4.2019)
4. ↑ Medical news today What and where are dermatomes? Available:https://www.medicalnewstoday.com/articles/what-are-dermatomes (accessed 25.5.2022)
5. ↑ David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
6. ↑ ^6.06.1 Apok V, Gurusinghe NT, Mitchell JD, Emsley HC. Dermatomes and dogma. Practical neurology. 2011 Apr 1;11(2):100-5.
7. ↑ ^{7.07. 1} Lee MW, McPhee RW, Stringer MD. An evidence-based approach to human dermatomes. Australasian Musculoskeletal Medicine. 2013 Jun;18(1):14-22.
8. ↑ Downs MB, Laporte C. Conflicting dermatome maps: educational and clinical implications. journal of orthopaedic & sports physical therapy. 2011 Jun;41(6):427-34.
9. ↑ ^9.09.1 Liebenson C, editor. Rehabilitation of the spine: a practitioner’s manual. Lippincott Williams & Wilkins; 2007.Available: https://www.sciencedirect.com/topics/medicine-and-dentistry/dermatome (accessed 25.5.2022)
10. ↑ Slide share. Dermatomes and myotomes. Available from: https://www.slideshare.net/TafzzSailo/special-test-for-dermatomes-and-myotomes (last accessed 23.4.2019)
11. ↑ ^11.011.1 Susan B.O’Sullivan, Thomas J. Schmitz, George D. Fulk. Physical Rehabilitation. 6th edition. F. A. Davis Company. 2014.
12. ↑ Downs MB, Laporte C. Conflicting dermatome maps: educational and clinical implications. journal of orthopaedic & sports physical therapy. 2011 Jun;41(6):427-34.

Dermatomes – Physiopedia

Original Editor – Lucinda Hampton

Top Contributors –

Naomi O’Reilly,

Anas Mohamed,

Lucinda hampton,

Joao Costa,

Nikhil Benhur Abburi,

Rachael Lowe,

Kim Jackson and

Blessed Denzel Vhudzijena

Lead Editors  

Contents

• 1 Dermatomes
• 2 History
• 3 Purpose
• 4 Technique
• 5 Controversies
• 6 Clinical Significance
• 7 References

The term “dermatome” is a combination of two Greek words; “derma” meaning “skin”, and “tome”, meaning “cutting” or “thin segment”. Dermatomes are areas of the skin whose sensory distribution is innervated by the afferent nerve fibres from the dorsal root of a specific single spinal nerve root, which is that portion of a peripheral nerve that “connects” the nerve to the spinal cord.

Nerve roots arise from each level of the spinal cord (e.g., C3, C4), and many, but not all, intermingle in a plexus (brachial, lumbar, or lumbosacral) to form different peripheral nerves as discussed above. This arrangement can result in a single nerve root supplying more than one peripheral nerve. For example, the median nerve is derived from the C6, C7, C8, and T1 Nerve Roots, whereas the ulnar nerve is derived from C7, C8, and T1.

In total there are 30 dermatomes that relay sensation from a particular region of the skin to the brain – 8 cervical nerves (note C1 has no corresponding dermatomal area), 12 thoracic nerves, 5 lumbar nerves and 5 sacral nerves. Each of these spinal nerves roots.^[1] Dysfunction or damage to a spinal nerve root from infection, compression, or traumatic injury can trigger symptoms in the corresponding dermatome. ^[2]

^[3]

Table. 1 Dermatomes

Nerve Root			Dermatome
Cervical	C2	Supply Skin of Neck	Temple, Forehead, Occiput
	C3		Entire Neck, Posterior Cheek, Temporal Area, Prolongation forward under Mandible
	C4		Shoulder Area, Clavicular Area, Upper Scapular Area
	C5	Supply the Arms	Deltoid Area, Anterior aspect of entire arm to base of thumb
	C6		Anterior Arm, Radial side of hand to thumb and index finger
	C7		Lateral Arm and Forearm to index, long, and ring fingers
	C8		Medial Arm and forearm to long, ring, and little fingers
Thoracic	T1		Medial side of forearm to base of little finger
	T2	Supply the chest and abdomen	Medial side of upper arm to medial elbow, pectoral and midscapular areas
	T3 – 6		Upper Thorax
	T5 – 7		Costal Margin
	T8 – 12		Abdomen and Lumbar Region
Lumbar	L1		Back, over trochanter and groin
	L2		Back, front of thigh to knee
	L3	Supply Skin of Legs	Back, upper buttock, anterior thigh and knee, medial lower leg
	L4		Medial buttock, latera thigh, medial leg, dorsum of foot, big toe
	L5		Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes
Sacral	S1		Buttock, Thigh, and Leg Posterior
	S2	Supply Groin	Same as S1
	S3		Groin, medial thigh to knee
	S4		Perineum, genitals, lower sacrum
Coccygeal	The dermatome corresponding with the coccygeal nerves is located on the buttocks, in the area directly around the coccyx. [4][5]

The idea of dermatomes originated from initial efforts to associate anatomy with the physiology of sensation. Multiple definitions of dermatomes exist, and several maps are commonly employed. Although they are valuable, dermatomes vary significantly between maps and even among individuals,^[6] with some evidence suggesting that current dermatome maps are inaccurate and based on flawed studies.^[7][8]

The medical profession typically recognised two primary maps of dermatomes. Firstly, the Keegan and Garret Map (Fig.1) from 1948, which illustrates dermatomes in alignment with the developmental progression of the limb segments. Secondly, the Foerster Map from 1933, which portrays the medial area of the upper limb as being innervated by T1-T3, depicting the pain distribution from angina or myocardial infarction. This latter map is the most frequently used in healthcare and accounts for the dermatomes used in the American Spinal Cord Injury Association Impairment Scale (ASIA Scale). In recent years there have been few attempts at verifying these original dermatome maps. Lee et al conducted an in-depth review that examined the discrepancies among dermatome maps. They put forth an “evidence-based” dermatome map that combined elements of previous maps (Fig.3). Though the application of the term “evidence-based” may be somewhat questionable, their proposed map represents a systematic attempt to synthesise the most credible evidence available.^[6][7]

Testing of dermatomes is part of the neurological examination. They are primarily used to determine whether the sensory loss on a limb corresponds to a single spinal segment, implying the lesion is of that nerve root (i.e., radiculopathy), and to assign the neurologic “level” to a spinal cord lesion^[9].

Dermatome Testing is done ideally with a pin and cotton wool. Ask the patient to close their eyes and give the therapist feedback regarding the various stimuli. Testing should be done on specific dermatomes and should be compared to bilaterally.

• Light Touch Test – Light Touch Sensation – Dab a piece of cotton wool on an area of skin ^[10]
• Pinprick Test – Pain Sensation – Gently touches the skin with the pin ask the patient whether it feels sharp or blunt

During the review of systems, asking the patient to carefully describe the pattern or distribution of sensory symptoms (e.g., tingling, numbness, diminished, or absent sensation) provides the therapist with preliminary information to help guide the examination and to assist in identifying the dermatome(s) and nerve(s) involved.^[11]

Light touch dermatomes are larger than pain dermatomes. When only one or two segments are affected, testing for pain sensibility is a more sensitive method of examination than testing for light touch.^[9]

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. There exist some discrepancies among published dermatome maps based on the methodologies used to identify skin segment innervation.

In a clinical commentary, Downs and Laporte discuss the history of dermatome mapping, including the variations in methodologies employed, and the inconsistencies in the dermatome maps used in education and practice.^[11] [[Laporte C. Conflicting dermatome maps: educational and clinical implications. journal of orthopaedic & sports physical therapy. 2011 Jun;41(6):42^[12]7-34.]]

Dermatomes are important because they can help to assess and diagnose a variety of conditions. Neurological screening of dermatomes helps to assess patterns of sensory loss that can suggest specific spinal nerve involvement. For instance, symptoms that occur along a specific dermatome may indicate disruption or damage to a specific nerve root in the spine.

• Nerve Entrapment
• Radiculopathy
• Spinal Cord Injury
• Herpes Zoster ^[2]

1. ↑ Wikipedia Dermatome. Available from: https://en.wikipedia.org/wiki/Dermatome_(anatomy) (last accessed 23.4.2019)
2. ↑ ^2.02.1 Medical news today What and where are dermatomes? Available:https://www.medicalnewstoday.com/articles/what-are-dermatomes (accessed 25.5.2022)
3. ↑ M Roehrs. Dermatomes. Available from: https://www.youtube.com/watch?v=CYZBH6NX8wg&feature=youtu.be (last accessed 23.4.2019)
4. ↑ Medical news today What and where are dermatomes? Available:https://www.medicalnewstoday.com/articles/what-are-dermatomes (accessed 25.5.2022)
5. ↑ David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
6. ↑ ^6.06.1 Apok V, Gurusinghe NT, Mitchell JD, Emsley HC. Dermatomes and dogma. Practical neurology. 2011 Apr 1;11(2):100-5.
7. ↑ ^{7.07. 1} Lee MW, McPhee RW, Stringer MD. An evidence-based approach to human dermatomes. Australasian Musculoskeletal Medicine. 2013 Jun;18(1):14-22.
8. ↑ Downs MB, Laporte C. Conflicting dermatome maps: educational and clinical implications. journal of orthopaedic & sports physical therapy. 2011 Jun;41(6):427-34.
9. ↑ ^9.09.1 Liebenson C, editor. Rehabilitation of the spine: a practitioner’s manual. Lippincott Williams & Wilkins; 2007.Available: https://www.sciencedirect.com/topics/medicine-and-dentistry/dermatome (accessed 25.5.2022)
10. ↑ Slide share. Dermatomes and myotomes. Available from: https://www.slideshare.net/TafzzSailo/special-test-for-dermatomes-and-myotomes (last accessed 23.4.2019)
11. ↑ ^11.011.1 Susan B.O’Sullivan, Thomas J. Schmitz, George D. Fulk. Physical Rehabilitation. 6th edition. F. A. Davis Company. 2014.
12. ↑ Downs MB, Laporte C. Conflicting dermatome maps: educational and clinical implications. journal of orthopaedic & sports physical therapy. 2011 Jun;41(6):427-34.

POLYMAG-01 in the treatment of patients with neurovascular syndrome in lumbar dorsopathy

Introduction
Study design
Treatment method
Study results
Conclusion
Treatment parameters

Introduction

Vertebrogenic diseases of the peripheral nervous system are observed in most cases in people aged 25-50 years and are the main cause of temporary disability (Kuznetsov VF 2000), which is a serious medical and social problem. In the nosological aspect, among other diseases, dorsopathy affects 5-10% of all patients.

Dorsopathy is a group of diseases of the musculoskeletal system and connective tissue, the leading symptom complex of which is pain in the trunk and extremities of non-visceral etiology. The most common cause of dorsopathies is osteochondrosis of the spine – a degenerative process in the intervertebral discs involving the bodies of adjacent vertebrae (spondylosis), intervertebral joints and the ligamentous apparatus of the spine (Fedin A. I. 2002).

Neurological manifestations of osteochondrosis of the spine account for about 50-80% (Voznesenskaya T.G., 2000) of all diseases of the peripheral nervous system, mainly during active work (Markin SP. 2005). In the first place in terms of frequency of occurrence is the defeat of the lumbosacral spine (60-80%).

Clinically osteochondrosis of the spine manifests itself as a reflex syndrome (occurs in 90% of cases) and compression (detected in 5-10% of cases). Compression syndromes are caused by the mechanical effect of a hernial protrusion, bone growths or other pathological structures on the roots, spinal cord or blood vessels. Compression syndromes, in turn, are divided into radicular (radiculopathy), spinal (myelopathy) and neurovascular syndromes (Yakhno N.N. 2001).

The most important type of dorsopathy is dorsalgia (back pain), which affects about 80% of the population during their lifetime (Waddel G. 1998). Among all types of dorsalgia, lumbalgia accounts for about 70%. More often than others, there are combined pain syndromes, in particular lumboischialgia, which has the following forms: muscular-tonic, neurodystrophic and neurovascular (Shostak N. 2005).

Neurovascular lesions with predominant localization in the limbs according to clinical manifestations are divided into vasospastic, vasodilatory and mixed types. The mechanism of vascular (dyscirculatory) lesions can be compressional, due to a direct effect on the radiculo-medullary vessels, or reflex (Visscher C.M., 2001), leading to acute or chronic insufficiency of the spinal roots or spinal cord, which leads to the development of motor disorders and impaired sensitivity ( Popelyansky Ya.Yu. 2003).

Taking into account the multifactorial nature of etiopathogenesis and the diversity of clinical manifestations of dorsopathy, it remains relevant to develop new methods for the rehabilitation of this pathology in order to increase the clinical effectiveness of treatment.

In the arsenal of methods used to treat this disease, an important place is given to the use of natural and preformed physical factors that have both local and general effects, causing adaptive reactions, activating the reserve capabilities of the body and aimed at stopping pain, correcting vascular disorders, improving the functional state nervous system.

Numerous studies testify to the wide therapeutic possibilities and high efficiency of low-frequency pulsed electromagnetic fields, the local effect of which has a pronounced anti-edematous, absorbable, anti-inflammatory, antispasmodic, analgesic, trophic-regenerative effect (Prato F. S. 2000). The magnetic field improves microcirculation in the perineural membrane, the trophic function of the myelin sheath, contributes to the normalization of the functional state of the neuromuscular apparatus.

The technical capabilities of most modern physiotherapy devices generating a low-frequency magnetic field are limited in terms of the area of ​​maximum impact on all pathogenetically and clinically significant areas of damage. In this regard, the presence of voluminous tape external inductors in the POLYMAG-01 apparatus makes it possible to provide the possibility of simultaneous exposure to large areas of the patient (trunk, legs), increasing the effectiveness of magnetic therapy in this nosology.

In the Russian Scientific Center for Restorative Medicine and Balneology of Roszdrav, clinical trials of the effect of a low-frequency traveling magnetic field generated by the POLYMAG-01 physiotherapy apparatus in patients with neurovascular syndrome with dorsopathy of the lumbar spine were carried out.

The device “POLIMAG-01” was produced in Russia: Elatomsky Instrument Plant.

The aim of the study was to study the feasibility and effectiveness of the low-frequency traveling magnetic field generated by the physiotherapy apparatus “POLYMAG-01” in patients with neurovascular syndrome with dorsopathy of the lumbar spine.

Criteria for inclusion in the study:

• Dorsopathy of the lumbar calving of the spine (osteochondrosis, lumboischialgic syndrome)
• The presence of discopathy (herniation, protrusion of the intervertebral disc) confirmed by data from MPT, CT of the lumbar spine
• Neurovascular syndrome (clinical data, lower extremity rheovasography parameters)
• Absence of absolute signs of atherosclerotic vascular lesions (lipid profile, ECG, etc. )
• Consent of the patient

Criteria for exclusion from the study:

• General contraindications to physiotherapeutic exposure to a magnetic field.
• Atherosclerotic vascular disease (dyslipidemia, coronary heart disease).
• Arterial hypotension

Table 1: Scheme of the clinical study of the effectiveness of “POLYMAG”

Study Design

The clinical study lasted 3 months. All patients participating in the study were divided into 2 groups comparable in age, duration of the disease, clinical and neurological status:
Group I (20 people) – patients with clinical manifestations of vertebrogenic lumboischialgia with neurovascular syndrome who received exposure to the physiotherapy apparatus “POLYMAG-01” with the help of external tape inductors on the lumbar region and lower limbs.

Group II (20 people) – patients with clinical manifestations of vertebrogenic lumboischialgia with neurovascular syndrome who did not receive medical procedures in the lumbar region and lower limbs ( control group).

During the follow-up period, patients received basic treatment

The procedures were performed against the background of basic treatment, including therapeutic exercises, swimming in the pool, iodine-bromine baths. No vascular drugs were used during the study period.

Treatment method

Patients with clinical manifestations of vertebrogenic lumboischialgia with neurovascular syndrome were exposed to a running low-frequency field from the POLYMAG-01 physiotherapy apparatus using external tape inductors on the lumbar region and lower limbs. The mode of exposure was within 15 minutes, daily, for a course of 10 procedures.

Clinical characteristics of patients

We observed 40 patients with clinical manifestations of vertebrogenic lumboischialgia with neurovascular syndrome with disease duration from 0.5 to 8 years, including 23 (57.5%) men and 17 (42.5%) women aged 39 to 51 years, the mean age of the patients was 45 years.

Disease duration from 0.5 to 1 year was observed in 7 patients, from 1 to 3 years – in 10 patients, from 3 to 6 years – in 14, from 5 to 8 years – in 9patients.

Depending on the duration and severity of lumboischialgic syndrome, patients were distributed as follows: acute stage – (pain syndrome duration up to 3 weeks) – 6 people; subacute and prolonged exacerbation stage (from 3 weeks to 3 months) – 12 people; chronic course (pain of varying intensity for more than 12 weeks) – 14 people; remitting course (absence of pain syndrome for the last 6-12 months) – 8 people.

The dominant complaint presented by patients was pain in the lumbar region of varying intensity and localization. The majority of patients (72%) noted the spread of pain to the lower limbs (more often to one), mainly along the posterolateral surface. The intensity of the pain syndrome at the time of admission to the hospital according to the visual analog scale of pain in patients averaged 4.8 ± 1.5 points. 53% of patients complained of cramps in the calf muscles.

Tension symptoms were detected in the vast majority of patients: Lasegue’s symptom (in 67%), Matskevich’s symptom (in 52% of patients).

Numbness and decreased surface sensitivity in the dermatomes corresponding to the affected segment were found in 54%

patients – L4 (32%), L5 (54%), SI (14%). Knee jerks were reduced in 24%, absent in 11%; Achilles reflexes were reduced in 48%, absent in 32% of patients. Long-lasting pain sensations in a number of patients were accompanied by sleep disturbance (24%), asthenic (16%) and depressive syndromes (7%) were less common. No dysfunction of the pelvic organs was observed in any of the examined patients.

According to MRI and CT of the lumbosacral spine, protrusions were detected in 32% of patients, and herniated discs in 53% of them – at the level of L5-S1 in 67%, L4-L5 – in 26%, L1-L4 – at 7%.

Analysis of rheovasograms of the lower extremities revealed in 47% of patients signs of angiospasm in the form of a decrease in the amplitude of the rheowave, lengthening of the anacrotic phase, displacement of the dicrotic tooth at the top of the curve, as well as a decrease in the rheographic index (RI) and an increase in the peripheral resistance index – the dicrotic index (DCI) reflecting the increased tone of small vessels.

Patients with vasospastic form complained of pain, chilliness, numbness of the lower extremities. On examination, vegetative disorders were observed in the form of discoloration of the skin, nails, dry skin, hyperkeratosis and pastosity of the feet.

In the vasodilatory variant, which occurs in 28% of patients, there was a feeling of heat and fullness in the lower extremities; examination revealed blanching of the lower leg and foot, marbling of the skin, cyanosis, increased pain with a change in body position. The hypotonic type of rheovasograms of the lower extremities is manifested by an increase in RI and a decrease in DCI. Most patients had elevated values ​​of the diastolic index (CI) on the shins and feet, which indicates a difficulty in venous outflow. The mixed type (22%) was characterized by a combination of the features described above.

Research results

Upon completion of the course of exposure to “POLYMAG”, a subjective and objective assessment of the effectiveness of treatment was carried out. In general, the procedures were well tolerated. As a result of the treatment, the majority of patients improved their general condition, there were positive changes in the subjective and objective manifestations of the disease. Efficacy analysis (significant improvement or improvement in performance) showed that the clinical effect was observed in 59% of cases.

As a result of the treatment, according to the VAS of pain (measured in cm), the intensity of the pain syndrome decreased from 4. 8 ± 1.5 points to 2.1 ± 1.6 points, while in the control group it decreased to 3.5 ± 0.5 points.

Against the background of the ongoing treatment, respectively, in 48% and 42% of patients of the main group, there was a positive dynamics of the symptoms of Lasegue and Matskevich in the form of a decrease in the angle of appearance of the pain syndrome.

The study of the dynamics of the activity of the reflex sphere revealed the activation of initially weakened tendon reflexes of the lower extremities in the main group in 52% of patients, at the same time, the appearance of initially absent reflexes was not observed.

Also in the main group, 78% of patients complaining of cramps in the calf muscles showed a significant decrease in the incidence of cramps. In the control group, a decrease in the frequency and severity of calf muscle cramps was recorded in 21% of patients.

In the main group, there was a trend towards a decrease in both systolic (SBP) and, to a greater extent, diastolic (DBP) blood pressure, which is probably due to the effect of peripheral vasodilation observed when exposed to a magnetic field (Table 2).

Table 2: Dynamics of blood pressure in patients with dorsopathy of the lumbar spine

*-Р<0.05

Rheovasographic studies have shown a favorable effect of “POLYMAG” on the regional hemodynamics of patients in the form of improving the shape and structure of rheographic curves, quantitative indicators of RVG. However, these positive changes mainly concerned patients with vasospastic type of peripheral circulation. An increase in initially reduced RI was noted (in 57% of patients with initially reduced RI), which characterizes an increase in pulse blood filling of the lower extremities; a decrease in the tone of small vessels was also observed in the form of a decrease in initially high values ​​of DCI (64% of patients). In 71% of patients, a decrease in CI was noted, which indicates an improvement in venous outflow.

In patients with hypotonic type of RVH, there was a significant decrease in initially elevated RI, CI and an increase in initially reduced RI in the main group in 28% of patients, while in 45% there was an increase in RI and that is probably due to the vasodilating effect of the magnetic field.

Table 3: Dynamics of lower extremity rheovasography parameters against the background of the POLYMAG-01 treatment for discogenic dorsopathy

Groups sick	RVG indicators	Values
1 group (n=20)	RI (Ohm)	0. 51±0.08* 0.78±0.05
	DKI (%)	43.9±2.1* 35.2±1.25
	CI (%)	39.4±2.5 35.4±1.6
group 2 (n=20)	RI (Ohm)	0.48±0.08 0.62±0.1
	DKI (%)	43.7±1.8 39.2±1.9
	CI (%)	40.2±1.8 39.2±1.5

Note: n is the number of patients;

in the numerator – indicators before treatment, in the denominator – after treatment *-Р<0.05

The content of total cholesterol in both groups was within the normal range (4.8±0.6 mmol/l, triglycerides – 1.3± 0.3 mmol/l) and no significant dynamics were observed during the treatment.

Thus, the course treatment with the influence of a magnetic field generated by the device “POLYMAG-01” in patients with neurovascular syndrome with discogenic dorsopathy of the lumbar spine contributed to a decrease in the severity of the radicular syndrome (lumboischialgia, cramps, sensory disorders) and improved peripheral hemodynamics (pre property in vasospastic type of circulation of the lower extremities).

Conclusion

Neurological manifestations of osteochondrosis of the spine account for 70-80% of all diseases of the peripheral nervous system, and in the first place in terms of frequency of occurrence is the defeat of the lumbosacral region (60-80%). Currently, pain in the lumbar region is widespread, and in developed countries, according to WHO experts, it has reached epidemic proportions, which in most cases is associated with increasing stress on a person.

The results of our clinical trials confirm the literature data on the pathogenetic relationship between damage to the peripheral nervous system in discogenic dorsopathy and the development of pathological vascular changes in the lower extremities. Thus, in the majority of patients with dorsopathy, we observed a vasospastic type of circulation in the legs with characteristic subjective manifestations, often accompanied by signs of venous discirculation. We have identified positive subjective and objective changes against the background of the course of physiotherapeutic exposure to a pulsed traveling magnetic field from the “POLYMAG-01” device on the lumbar region and lower limbs. Such an effect had an improvement in the general well-being of patients, a moderate analgesic effect, an antispasmodic effect in the initially vasospastic type of peripheral circulation, a moderate hypotensive effect with no side effects. The resulting vasodilation effect in patients with neurovascular changes in discogenic lumbar dorsopathy requires further more detailed study, especially in patients with an initially vasodilatative type of blood circulation in the lower extremities. Perhaps this category of patients should be limited to exposure to a magnetic field only on the lumbar region.

Thus, the results of the conducted clinical studies make it possible to recommend a course of physiotherapy with a pulsed traveling magnetic field from the POLYMAG-01 device on the lumbar region and lower limbs of patients with neurovascular syndrome with dorsopathy of the lumbar spine in complex spa treatment.

Treatment parameters

Running low-frequency field from the physiotherapeutic apparatus “POLYMAG-01” with the help of remote tape inductors to the lumbar region and lower limbs.

Mode of action – 15 minutes, daily, 10 procedures per course.

Neurologist, Department of Rehabilitation of Patients with Diseases of the Nervous System, Ph.D. Sci. Markov D.V.
Chief Physician for Research and Clinical Testing, Dr. med. Sciences Efendieva M.T.

Source: Collection of articles on the use of the device POLIMAG-01

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Treatment of protrusion of the lumbar spine

Pain in the lower back and legs is most often caused by a protrusion of the disc. In the initial stages, the disease does not manifest itself, but with the growth of protrusion, it protrudes into the region of the spinal canal, resulting in a radicular syndrome or stenosis of the spinal canal. This is accompanied by painful sensations. In the lumbar region, protrusions are diagnosed quite often, since this area has a strong physical load. Over time, the pathology, in the absence of proper treatment, turns into a hernia.

Small protrusions are not visible on X-ray or MRI and do not require special treatment. If the pathology causes severe back pain, drug therapy is required. The operation is performed when the patient has compression of the nerve structures, which worsens the functioning of the internal organs.

Causes of protrusion

Protrusions develop due to wear of the intervertebral discs. This process is accelerated by injuries, obesity, lack of physical activity. Other factors that lead to the occurrence of this pathology are:

• difficult working conditions associated with regular heavy lifting;
• incorrect posture;
• smoking;
• sedentary;
• long stay in an uncomfortable position;
• bad food.

This disease occurs when there is a sudden load on the spine, which is possible in an accident and violation of heavy lifting technique.

People who have genetic defects and are prone to degenerative damage are predisposed to the formation of protrusion. Pathology is also likely in patients with congenital anomalies of the spine.

With age, the tendency to lumbar protrusion increases. To prevent the development of pathology, it is recommended to lead an active lifestyle and eat right.

Main symptoms

Pain is the main symptom. It can be discogenic, localized in the region of the lumbar dermatome, or radicular. The latter is characterized as sharp, shooting through. It occurs when performing certain movements, and intensifies at night. Radicular pain extends to the lower extremity.

When the root is compressed, dermatomal pain occurs. The localization of such pain depends on which root is squeezed. With compression of the L1 root, patients note pain in the region of the inguinal dermatome. Complaints of pain in the anterior and lateral surface of the middle part of the thigh indicate compression of the L2 root.

Pain in the inner and anterior-lower part of the thigh is noted during compression of the L3 root. Localization of pain in the anterior or posterior part of the lower leg is a sign of compression of the L4 P root, and the lateral region is a sign of compression of the L5 P root. In the latter case, the pain passes to the area of ​​the patient’s foot.

Pain in the lateral area of ​​the feet indicates compression of the S1 root. When squeezing S2, pain is noted in the femoral zone and in the lower leg.

Tingling is noted in the dermatome of the nerve roots L1-S2. Numbness also spreads in this area. Severe pain in the patient is caused by muscle spasm associated with the accumulation of lactic acid in them. It occurs between the vertebrae L1 and L5.

As a result of lumbar protrusion, patients feel weakness in the lower limb, movements are difficult for them. When the roots of L1 and L2 are affected, there are problems with hip flexion. If, in addition, the patient flexes the knee joint with force, there is a problem at the level of the L3 root.

Movement in the knee joints and extension of the toes becomes more difficult when the L4 root is damaged. The big toe cannot be lifted up with an L5 lesion. Muscle weakness when performing movements in the knee joints is characteristic of the defeat of the S1 root.

In addition, damage to the roots of L4-5 and S1 leads to a decrease or complete disappearance of the Achilles reflex in the patient. An abnormal reflex of the knee joint indicates pathology of the L2 and L3 roots.

With protrusion, patients lose their appetite, as a result of which their weight decreases. Loss of muscle mass is the main cause of weakness and leads to wasting of the limbs. Due to constant pain, patients suffer from insomnia. In severe cases, as a result of aggravation of the pathology, the functions of the bladder are impaired. The patient may also lose control of bowel movements.

It is recommended to consult a doctor when the first symptoms of protrusion appear, then the treatment will be short and most effective.

Diagnosis

A doctor can diagnose protrusions after a complete examination of the patient. The following methods are used for this:

• MRI;
• CT.

The patient is also referred for a blood test to determine the cause of the protrusion. If the study shows a high ESR, the cause of the pathology may be a tumor or epidural abscess. An increased content of C-reactive protein is observed in patients with rheumatological diseases. An excessive number of leukocytes is characteristic of infectious pathology, osteomyelitis and epidural abscess.

EMG helps to assess the degree of nerve damage due to protrusion. If a tumor or infection is suspected, the patient is referred for a PET scan of the bones.

X-ray does not show protrusion, but may reveal trauma and spinal abnormalities that may have caused this condition.

If a lumbar protrusion is suspected to be caused by osteoporosis, bone densitometry is performed to determine bone density.

Treatment

Treatment of a protrusion of the lumbar spine should be aimed at relieving pain and inflammation, as well as restoring function. To alleviate the condition, the patient is recommended to wear a corset.

If protrusion pain is mild, medical treatment is sufficient. The patient is prescribed analgesics and anti-inflammatory drugs. Prescription pain relievers can help with severe pain. For this purpose, glucocorticosteroids, Tramal, opiates and opioids are used. These medications quickly relieve pain, but with prolonged use they are addictive. For this reason, the treatment of protrusion of the lumbar spine with their help takes place in a hospital.

The treatment of lumbar protrusion necessarily includes the use of muscle relaxants. They stimulate the locus coeruleus in the brainstem and increase the production of norepinephrine, thereby reducing spasm in skeletal muscles. Of the muscle relaxants, the use of Skelaxin, Robaxin, Cyclobenzaprim is practiced.

For lumbar protrusions, the patient is prescribed antidepressants. They are used for chronic pain, as well as in situations where prescription analgesics have many side effects. Milnacipran, Duloxetine, tricyclic antidepressants have a calming effect.

Since severe pain causes anxiety and impairs sleep, patients should be sedated.

Antiepileptic drugs can help manage chronic neuropathic pain in situations where NSAIDs, corticosteroids, opiates, and opioids are difficult to tolerate. Pregabalin or Gabapentin are prescribed for this purpose. These medications are taken under medical supervision.

Interventional therapies for severe pain are also effective for protrusions. They are performed using x-rays. To relieve inflammation of the disc and root allows translaminar or caudal epidural injection of corticosteroids.

A trans-foraminal epidural injection is administered into the area of ​​root compression. Thanks to interventional methods, drugs enter directly into the lesion in the maximum concentration. The procedure is performed under local anesthesia and lasts about 20 minutes. The patient remains under the supervision of a doctor for 2 hours, after which he is allowed to go home. The advantage of this therapeutic method is a quick result and the removal of inflammation for a long time.

Medical treatment of protrusion of the lumbar spine only alleviates the symptoms of the pathology. Positive dynamics is observed only when strengthening the muscular frame and spine through physical exercises.

Manual therapy for protrusions

If the protrusions are small, the patient’s condition is facilitated by manual therapy. It helps to quickly cure the pathology without the use of interventional methods and surgery.

At the first sign of pain, osteopathic manual therapy is quite effective. To improve blood supply and relieve muscle spasms, the patient is sent for a massage. Massage the lumbar and sacral regions. This takes into account that tapping and patting movements lead to the disc falling out. You should undergo the procedure in a medical institution, since a special massage technique is used for protrusion.

Physiotherapy exercises improve the motor activity of the spine. Training should be aimed at developing flexibility and include elements of stretching. The spine is strengthened through weight training. It is recommended to change position as often as possible and spend less time in a sitting position, since this places the greatest load on the spine.

Pain is relieved by acupuncture and physiotherapy. Especially effective are transcutaneous electrical stimulation, ultrasound, magnetotherapy, and cryotherapy. MBST therapy allows you to speed up the recovery of damaged discs. These techniques are not acceptable during the period of acute pain.

Manual therapy, massage and physiotherapy are also recommended as a prophylaxis for protrusions of the lumbar spine.

Surgery

If medical treatment fails, the patient is recommended surgery. Thus, it is possible to reduce the pressure on the nerves. A suitable technique is selected taking into account the severity of the protrusion. With minimally invasive procedures, rehabilitation is fast.

Surgical techniques include:

1. Microdiscectomy. This method is less invasive, rarely leads to negative consequences. The operation allows not only to reduce compression, but also to replace a damaged disk. Complications include rupture of the spinal membrane, damage to the nerve root, bleeding, and infection.

2. Percutaneous nucleoplasty. The technique is also minimally invasive and involves the introduction of a puncture needle. Cold plasma is applied to the affected area. An x-ray is required during the operation. The patient can walk 2 hours after the intervention.

3. Discectomy. This operation involves the removal of a damaged disk. It is prescribed in situations where the patient’s nerve is damaged, which leads to loss of sensation in the limbs and dysfunction of the bladder. The intervention can be open or minimally invasive, using a microscope.

4. Laminectomy involves the removal of a piece of bone tissue above the root and a small part of the disc below it. The technique is practiced infrequently, since there are less invasive ways to relieve compression. During the operation, if necessary, stabilize the spine.

5. If decompression surgery fails, fusion surgery is recommended.

For the treatment of lumbar protrusion, in most cases, medications and exercise therapy are enough. Surgery is rarely resorted to, mainly if there is no improvement within 3 weeks after the start of therapy. During the rehabilitation period, it is necessary to reduce the load. It takes several months to restore the functions of the spine. To reduce the likelihood of recurrence of the disease, you need to monitor your posture and exercise. Exercises are selected individually and require regular repetitions.

Benefits of MBST

Lumbar protrusions can be treated without surgery. For the treatment of the back, an innovative MBST-therapy technique is recommended. It is completely safe for the patient and does not cause any complications.