Cause Of Nerve Root Compression Research Articles

Patient with discogenic radiculopathy: diagnostic and treatment algorithms

Low back pain is one of the most common causes of seeking medical care, loss of ability to work, and is a heavy socio-economic burden for the country. In the vast majority of cases, the pain syndrome is musculoskeletal, associated with pathology of joints, muscles and ligaments and is benign in nature. Discogenic compression-ischemic radiculopathy is less common, but this pathology is associated with a wide range of issues in differential diagnosis and correct treatment tactics for patients. This article provides an overview of modern clinical guidelines for the diagnosis and treatment of discogenic radiculopathies. The diagnosis of discogenic radiculopathy is clinical. MRI of the spine is performed to exclude secondary causes of nerve root compression if treatment is ineffective. An important direction in the treatment of radiculopathy is non-drug treatment, which includes informing the patient about the benign nature of the disease, the possibility of spontaneous regression of a disc herniation, therapeutic exercises, maintaining the maximum tolerated amount of physical activity, social and professional activity Treatment of back pain is associated with an increased risk of side effects of non-steroidal anti-inflammatory drugs, which patients often use uncontrollably. The issue of safe relief of pain syndromes remains relevant. This can be achieved using a combination of non-steroidal anti-inflammatory drugs and high-dose B vitamins. B vitamins also have a neurotrophic effect, which allows the restoration of impaired neurological functions.

Comparison between Neural Mobilization and Mckenzie Approach in Reducing Pain, Improving Mobility and Functional Ability in Peoples with Lumbar Radiculopathy

Background: Lumbar radiculopathy is the compression of lumbar nerve root. The most common causes of nerveroot compression are intervertebral disc herniation and degenerative alterations. About 3% of cases, disc diseasecauses lumbar radiculopathy. Pain is the major symptom.Purpose: The study is to compare the effectiveness of neural mobilisation and McKenzie approach in reducingpain, improving mobility and functional ability for peoples with lumbar radiculopathy.Materials and Methods: A Experimental study which consists of 64 subjects who were selected based on inclusionand exclusion criteria from A.K.B physiotherapy during the period of November 2022 to April 2023. They weresplit into two groups , the Neural mobilisation group(n=32) and McKenzie group(n=32).The intervention wasgiven for 5 days a week for 4 weeks . The pre and post test values were measured using (NPRS), Modified Schober’smethod and (MODI).Results: With a p value of 0.0001, the mean of the Neural Mobilization at the post test was shown to be greaterthan the mean of McKenzie Exercise.Conclusion: This study concluded that Neural mobilisation was found to be more effective than McKenzie indecreasing pain , improving mobility and functional ability for peoples with lumbar radiculopathy.

Role of MRI to Rule Out Non Discogenic Causes of Nerve Root Compression

Objective: The purpose / intention of this study is to highlight that MRI is good diagnostic tool to interpret non discogenic causes of lumbosacral radiculopathy because of nerve root compression. Study Design: Cross-sectional descriptive study involving Medical Imaging (MRI) and clinical review. Place / Duration of the Study: This above mentioned study was piloted conducted in Diagnostic Radiology Wing of DHQ / Teaching Hospital, Gujranwala from 1st July 2017 till 30TH June 2018. Materials and Methods: 100 Patients with history of backache referred for MRI spine were scanned after informed consent atSiemens Syngo 1.5T MR system. Non-ionic Gadolinium contrast was used in suspected discospondylitis. Results: It was concluded from our study that lumbosacral ratio of nerve root compression due to non-discogenic causes (52%) (n=52) is greater than disc prolapse causes (48%) (n=48). Most common non discogenic cause of nerve root compression was facet joint hypertrophy. Other non discogenic causes of nerve root compression include traumatic (10%), Spondylolisthesis (5%), infection (14%), Neoplastic (2%) and sequestered disc segment (2%). Disc bulge was major discogenic cause of nerve root compression at lumbar spine. Conclusion: MRI provide valuable information regarding detection of lumbar radiculopathy causes. Most common causes of lumbar radiculopathy are non-discogenic pathologies rather discogenic cause. Keyword: Magnetic resonance imaging (MRI); Discogenic; Non discogenic; Spondylolisthesis; (LBP) Lower back pain.

Long-term follow-up results of surgically treated patients with foraminal and far lateral disc herniations

Purpose Foraminal and far lateral disc herniations are rarer cause of nerve root compression. There are reports regarding the outcome, however long-term follow-up results of surgically treated patients are few. The purpose of this retrospective study is to analyze the clinical characteristics and long-term surgical outcomes of the foraminal and far lateral disc herniations. Materials and methods The 114 patients who underwent an operation for foraminal and far lateral disc herniaitions were reviewed. Visual analogue scale of back and leg pain, the ocurrence of motor deficit and sensory dysesthesia before and after operations were used to compare the results of early and long-term outcome. Results A total of 114 telephone interviews were conducted. The mean follow up was 134 months. Complete relief of symptoms were reported by 77 patients (67.1%). The average VAS of radicular leg pain was 7.5 Post-operatively the average VAS of radicular pain decreased to 2.2. Preoperatively, 9 patients (7.6%) had motor deficit and 17 (14.4%) patients had sensory dysesthesia. Post-operatively 9 (100%) of the patients showed motor, and 12 (70.6%) of the patients showed sensory improvement. In 17 patients with hypoesthesia the complaints continued during 2 weeks to 6 months. They were given gabapentin as medical treatment, however 5 of these patients still have sensory dysesthesia. The outcome was: 67.1% excellent (77 patients), 26.3% good (30 patients), 6.1% fair (7 patients). Conclusion The far lateral approach is a minimally invasive and safe procedure with low complication rates.

SURGICAL TREATMENT OF ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE CENTRAL LUMBAR SPINAL STENOSIS

Objective. To analyze the results of surgical treatment of patients of the older age group with central spinal stenosis at the lumbar level. Material and Methods. A total of 107 patients of elderly and senile age with clinically significant degenerative central stenosis of the spinal canal were treated. They were divided into two groups: patients in Group 1 underwent bilateral decompression of nerve roots through unilateral approach; those in Group 2 - nerve root decompression supplemented with interbody fusion and transpedicular fixation. Results. The surgery resulted in statistically significant reduction in pain, improvement of the quality of life, enlargement of spinal canal dimension parameters, and increase in the distance of walking. Statistical difference in the quality of life between Groups 1 and 2 was revealed for the indicator characterizing the psychological component of the SF-36 questionnaire (p = 0.03); there were no statistical differences for the remaining indicators. The key parameter for assessing central stenosis is the cross-sectional area of the dural sac. Conclusion. Preoperative examination of patients of the older age group should be comprehensive and include CT myelography with 3D reconstruction. The cause of nerve root compression in central stenosis is a combination of various factors in 41.9 % of cases. Differential surgical tactics provides an improvement in the quality of life in 80 % of cases. Excessive decompression does not improve the quality of life of patients. Instrumental fixation does not improve the outcome of surgical intervention and should be used only for clinically significant instability of the spinal motion segment.

Microendoscopic Posterior Decompression for the Treatment of Lumbar Lateral Recess Stenosis

Lateral recess stenosis (LRS) is a characteristic type of lumbar spinal canal stenosis, with symptoms of nerve root compression. The most common etiology is hypertrophy of the superior articular process. Conventional laminectomy and medial facetectomy are commonly used to treat LRS. This study investigated microendoscopic posterior decompression for the treatment of LRS. Microendoscopic decompression was performed on 28 patients. Computed tomography and magnetic resonance imaging were used to calculate the lateral recess angle and depth. A 16 mm diameter tubular retractor and endoscopic system were used. Unilateral paramedian approaches were performed in all patients. Even using a unilateral paramedian approach, both sides of the nerve roots were decompressed in patients with bilateral radiculopathy. Preand postoperative status was evaluated using the visual analogue scale (VAS). Patient’s mean age was 62.9 years; there was single-level involvement, mostly at L4-5 (85.7%). Intraoperative findings revealed that the most common cause of nerve root compression was hypertrophy of the superior articular process and ligamentum flavum. VAS score improved in all patients following posterior decompression. Pre- and postoperative mean VAS scores were 6.5 and 1.1, respectively (P value < 0.01). No intra- or postoperative complications were observed during a mean follow-up of 10.5 months.

Mimickers of Cervical Radiculopathy.

Degenerative changes of the cervical spine are the primary cause of nerve root compression leading to symptomatic radiculopathy. Genetic and age-related changes, including loss of intervertebral disc height, as well as facet and uncovertebral joint hypertrophy, produce narrowing of the neural foramen. A herniated nucleus pulposus may cause acute foraminal stenosis. Symptomatic nerve root compression may ensue, leading to pain radiating from the neck into the shoulder, arm, forearm, and/or hand, with or without accompanying numbness and paresthesias. Several musculoskeletal and nonmusculoskeletal entities have a presentation similar to that of cervical radiculopathy and can be easily overlooked if the diagnosis of radiculopathy is assumed (Table I). Therefore, the clinician should be familiar with the classic signs and symptoms of cervical radiculopathy as well as a spectrum of differential diagnoses that may mimic it. View this table: TABLE I Mimickers of Cervical Radiculopathy by Nerve Root Patients with cervical radiculopathy may report antecedent trauma, but the typical onset is more insidious. Acute, severe pain in a dermatomal distribution typically results from cervical disc herniation, whereas subacute, chronic, or intermittent radicular pain tends to be secondary to a chronically herniated disc or degenerative foraminal stenosis. Henderson et al.1, in a report on >700 patients who had been diagnosed with cervical radiculopathy, noted upper extremity pain in 99.4% of the patients, sensory changes to pinprick in 85.2%, neck pain in 79.7%, diminished reflexes in 71.2%, and diminished strength in 68%. Nearly 54% of the patients experienced pain or paresthesias in a dermatomal pattern, …

An anatomical study of the lumbar external foraminal ligaments: appearance at MR imaging.

The purpose of this study was to examine the MRI appearance of the ligaments within the external space of the lumbar intervertebral foramen by correlating MR images with the corresponding anatomic dissection of the cadaver lumbar spine. This was a two part study. Part I of the anatomic study consisted of the dissection of lumbar specimens from one embalmed adult male cadaver. At each lumbar level the external ligamentous structures were identified and their origin, insertion and position were determined. Part II of the study consisted of the anatomical analysis of the external transforaminal ligaments in the 180 lumbar intervertebral foramina on the MR images (1.5 T) in the sagittal plane. The diagnostic procedure was performed on 18 individuals from 18 to 25 years of age. The external transforaminal ligaments were observed at all levels and from both sides in the lumbar intervertebral foramen. The presence of the superior corporotransverse ligament was found in 45.56% intervertebral foramina, while the inferior corporotransverse ligament was found in 61.67% intervertebral foramina in the MRI. Our results confirm that external transforaminal ligaments are common structures in the intervertebral foramen. The results of this study show that the external transforaminal ligaments can be clearly visualized in MR images. It is crucial to have previous knowledge of the cadaveric specimens to recognize the transforaminal ligaments in MR images. The presence of these ligaments is clinically important because the ligaments could be the cause of nerve root compression or the low back pain syndrome.

Cervical Radiculopathy: A Review

Cervical radiculopathy is defined as a syndrome of pain and/or sensorimotor deficits due to compression of a cervical nerve root. Understanding of this disease is vital for rapid diagnosis and treatment of patients with this condition, facilitating their recovery and return to regular activity. This review is designed to clarify (1) the pathophysiology that leads to nerve root compression; (2) the diagnosis of the disease guided by history, physical exam, imaging, and electrophysiology; and (3) operative and non-operative options for treatment and how these should be applied. The PubMed database was searched for relevant articles and these articles were reviewed by independent authors. The conclusions are presented in this manuscript. Facet joint spondylosis and herniation of the intervertebral disc are the most common causes of nerve root compression. The clinical consequence of radiculopathy is arm pain or paresthesias in the dermatomal distribution of the affected nerve and may or may not be associated with neck pain and motor weakness. Patient history and clinical examination are important for diagnosis. Further imaging modalities, such as x-ray, computed tomography, magnetic resonance imaging, and electrophysiologic testing, are of importance. Most patients will significantly improve from non-surgical active and passive therapies. Indicated for surgery are patients with clinically significant motor deficits, debilitating pain that is resistant to conservative modalities and/or time, or instability in the setting of disabling radiculopathy. Surgical treatment options include anterior cervical decompression with fusion and posterior cervical laminoforaminotomy. Understanding the pathophysiology, diagnosis, treatment indications, and treatment techniques is essential for rapid diagnosis and care of patients with cervical radiculopathy.

Annular tears, fissures or HIZ?

Low back pain (LBP) is an acute or chronic pain in the lumbar or sacral regions [1], is highly prevalent and has substantial socioeconomic implications [2]. Jensen et al noted that low back pain is the second most common reason that patients seek medical care in the United States and that the estimated annual cost of related medical care is more than $8 billion [3]. Robertson noted also that the rate of low back–related disability has grown at a rate 14 times that of the population during the last 30 years [3]. MRI is established as the investigation of choice for assessing patients presenting with low back pain (LBP) and sciatica; recognised causes of nerve root compression include disc herniation and spinal stenosis, however many patients presenting with LBP and pain referred to the lower limb(s) show no evidence on imaging studies of nerve root compression, suggesting that there are other factors involved in the production of pain [4]. One of the prominent somatic sources of low back pain is the internal disc disruption of the lumbar spine, the socalled discogenic lumbar pain, which is the condition causing back pain without radiculopathy [5]. The annulus fibrosus is innervated by the recurrent meningeal nerve and by the small branches from the ventral ramus of the somatic spinal nerve; a proposed mechanism for such pain is inflammation of nerve roots (chemical radiculopathy) from leak of degenerative nuclear material through full-thickness annular tears [4, 5]. Compared with asymptomatic disks, painful disrupted lumbar intervertebral disks have higher concentrations of sensory fibers in their endplates and nucleus; this high concentration of sensory fibers, combined with increased levels of proinflammatory mediators such as IL-8 and PGE2, provides a substrate for hyperalgesia and presumably pain [6]. In this hyperalgesic state, even normal mechanical loading will be painful [6]. The concept of diskogenic pain caused by nocioceptive ingrowth into annular fissures has been supported only indirectly by observing a strong correlation between pain provocation and the presence of annular fissure during provocation diskography and subsequent CT imaging; annular fissures reaching the outer annular fibers are in fact the source of symptoms in patients suffering from chronic diskogenic LBP [6]. Discogenic lumbar pain is characterized by nonradicular pain, has a somatotropic rather than dermatomal pattern of pain projection; therefore, the use of symptoms and clinical findings to localize the level of abnormality is difficult; the source of discogenic pain is still unknown [7]. Ideally, a history and physical examination would consistently diagnose the source of a patient’s low back pain, and, if one diagnosed pain secondary to the intervertebral disc, one would be able to identify the exact level or levels involved; in reality, however, the exact source of low back pain is often illusive, because discogenic pain projects in a somatotropic rather than a dermatomal pattern, confirming and localizing a discogenic source, much less the exact level, using clinical findings alone remains unproven [8]. MR imaging provides an unique means to evaluate the morphologic status of intervertebral disks and their relationship to neural structures in patients with low back pain; moreover, the technique allows assessment of the biochemical status of the disk on T2-weighted spin-echo and fast spin-echo MR images [7]. One of the first structural abnormalities that predicted concordant pain provocation during disc stimulation was high-signal-intensity zones (HIZ) at first described by Aprill and Bogduk in 1992 [8]. HIZ are defined as small foci of high signal intensity at:

Symptomatic Epidural Gas Cyst Associated With Discal Vacuum Phenomenon

Four cases of computed tomography and magnetic resonance imaging documented lumbar nerve root compression associated with a vacuum disc communicating with the epidural space are presented. To give an insight into the mechanism of nerve root compression associated with vacuum disc phenomenon. Few cases of lumbar radiculopathy resulting from epidural gas have been reported and illustrated using cross-sectional imaging studies. The medical records, imaging examinations, and surgical findings (when available) of 4 symptomatic patients with epidural and intradiscal gas collections were reviewed. Three patients underwent surgery with needle aspiration of the epidural gas, and 1 patient was treated conservatively. Clinical symptoms of epidural gas cyst were similar to those of other more common causes of nerve root compression. Computed tomography and magnetic resonance imaging findings showed intraspinal gas collection associated with a vacuum disc. One patient had an additional vertebral pneumatocyst. Although evacuation of intraspinal gas resulted in complete cure or major neurologic improvement in 3 patients, an initial period of observation is warranted because gas may disappear spontaneously as in 1 of our patients. All 4 patients recovered full motor and sensory functions of the lower extremities. One year later, patients were completely free of symptoms. Although the vacuum disc is considered a common imaging finding of no or not much pathologic significance, occasionally intradiscal gas may leak into the spinal canal. Detection of an epidural gaseous collection at the same level with a vacuum disc strongly suggests a communication between the intervertebral disc and the epidural space. Epidural gas collections can be implicated as a possible cause of radicular symptoms and should be considered in the differential diagnosis of lumbar radiculopathy.

Acute Hemorrhagic Cyst of the Ligamentum Flavum

A case report and clinical discussion. To describe a rare complication of a cyst of the ligamentum flavum, which bled spontaneously, provoking an acute lower limb monoparesis and lumbar sciatic pain. SUMMARY OF BACKGROUNDS DATA: Cysts of the ligamentum flavum have been rarely reported. Intraspinal degenerative cysts described in literature are usually juxta-articular (synovial and ganglion) cysts and have a similar radiologic appearance. They are preferentially located in the lumbar spine, while the cervical localization is unusual. Hemorrhage into the cyst is an uncommon complication and an extremely rare cause of nerve root compression. A 59-year-old woman presented with sudden severe radicular lumbar deficit and pain secondary to acute hemorrhage into a ligamentum flavum cyst. Magnetic resonance imaging showed at L3-L4 level a lobulated slightly hyperintense mass with a ventral area of marked hyperintensity in T1 images, hypointense on T2 images. Signal within the lesion was suggestive of intralesional hemorrhage. Complete resection of the lesion was performed, resulting in immediate recovery. The cyst was quite rounded, brownish, and contained rest of both partially fresh and coagulated hematoma. Histologic examination revealed myxoid degeneration of the ligamentum flavum with an hemorrage in the cystic cavity without a synovial layer. This report identifies a rare case of radicular lumbar deficit and pain secondary to acute hemorrhage into a ligamentum flavum cyst. The pathogenesis and clinicopathologic characteristics of this lesion are described.

Arthroscopic Microdiscectomy of the Lumbar Spine

Disc herniation in athletes is uncommon; however, it requires prompt diagnosis and treatment. Arthroscopic microdiscectomy is associated with minimal postoperative morbidity and it is particularly suitable for the surgical treatment of unremitting radiculopathy associated with herniated lumbar disc in athletes. The addition of the arthroscope and the deflecting instruments allows for visualization, identification, and extraction of posterior and posterolateral collagenized nuclear fragments that are believed to be the common cause of nerve root compression and sciatica following disc herniation.