Nerve Root Irritation Research Articles

Nerve Root Compression and Night Cramps

To the Editor.— I read with interest Dr Sugar's delineation of nerve root compression secondary to lumbar spondylosis as a of night cramps. I do not think that Dr Cutler's reply took proper account of Dr Sugar's extensive and reliable professional experience. In my 15 years of experience, seeing over 1,500 patients with lumbar disk disease and spondylosis, I have found night cramps to be a very common problem. Twenty percent to 30% of my patients complain of night cramps in the lower aspect of the leg appropriate to the compressed nerve root: L5, anterior compartment; S1, posterior compartment. This complaint may persist despite definite surgical decompression, medication, physical therapy, and education. In the past decade, it has become more evident that nerve root compression and irritation frequently cause a loss of balance among the sensory, motor, sympathetic, and gamma system functional components of a nerve. Other clinical examples

Causes of Night Cramps-Reply

In Reply.— Dr Sugar believes that lumbar spondylosis could be a common cause of nocturnal cramps and suggests this hypothesis be tested in any low-back pain clinic. I would urge that he do so; anecdotal data have little value. Having searched the literature and textbooks, nowhere do I find nerve root irritation to be a cause of night cramps. Leg pain and low-back muscle spasm—yes! Leg pain and leg muscle spasm—no! The coincidence of night cramps and lumbar spondylosis may simply represent the concurrence of two common but unrelated problems in the elderly. The theory presented by Dr Sugar seems plausible, but it is not substantiated by clinical research or published material. Furthermore, the pharmacologic reasons for the beneficial effects of quinine and diphenhydramine are far more complex than their actions on the myoneural junction.

The facet joint and its role in spine pain. Management with facet joint injections.

Mechanical derangements of the lumbar spine, causing predominantly back pain with the absence of nerve root irritation or compromise, present a difficult treatment challenge to the average physician. The author suggests that facet joint injections offer a simple, safe, and often dramatically effective means for managing these problems. The historic background and technique are described in detail. The author presents his personal experience with 99 patients receiving a total of 117 facet joint injections in this retrospective, uncontrolled review. Results were classified as excellent in 17%, good in 25%, fair in 9%, mediocre in 4%, and no change in symptoms occurred in 44%. The procedure is recommended for diagnostic and conservative therapy.

Pain and Enlargement of an Amputated-Leg Stump-Reply

In Reply.— The patient's lancinating pain is clearly indicative of nerve irritation, which, contrary to Dr Singer's impression, need not result in atrophy of muscle even after many years, as patients with arachnoiditis or herniated disk will attest. Indeed, cases are on record with muscle hypertrophy caused by chronic nerve root irritation. Abnormal vessels rather than a scar might compress or irritate nerves in the stump, as is postulated by some for hemifacial spasm. Both Dr Singer and I agree that recurrent arteriovenous malformation accounts for the limb enlargement and the patient should be investigated angiographically. A properly fitted prosthesis can only benefit the patient, and Dr Singer's suggestion in this regard is well worth following.

Use of liquid crystal thermography as an aid in the diagnosis of nerve root compression and irritation in painful states

Use of liquid crystal thermography as an aid in the diagnosis of nerve root compression and irritation in painful states

Commissions for complaints.

Brucellosis in Britain is usually caused by Bruceila abortus and mainly affects those in direct contact with cattle or their un pasteurised milk products.1 2 Bone and joint brucellosis consti? tutes about 9% of brucellosis infections and the spine is the commonest site of skeletal infection.1 3 Brucellar spondylitis most often presents with back pain and leg pain, resembling an inter vertebral disc protrusion. Girdle pain has been reported.1 2 4 Para vertebral abscesses are uncommon in brucellosis.4 It is most unusual for brucellar spondylitis to present as right upper quadrant pain. A paravertebral abscess could produce nerve root and diaphragmatic irritation, resulting in right hypochondrial pain with radiation to the right shoulder tip. In skeletal brucel? losis the cultures are frequently negative in keeping with the late stage of the disease.3 4 Early serological studies may be crucial to the diagnosis. Treatment with tetracylines and streptomycin is successful in most cases.1-4 Surgery is indicated for spinal brucellosis only if there is instability, vertebral collapse with cord compression, or failure of a thick walled paravertebral abscess to respond to medical treatment.4

Detection of osteoporotic sacral fractures with radionuclides.

Osteoporotic sacral fractures usually occur in elderly patients as a result of mild trauma. Clinical symptoms range from localized sacral tenderness to neurologic problems attributable to sacral nerve root irritation or cauda equina compression. Although the radiographic diagnosis is difficult to establish, bone scans show a characteristic H-shaped pattern of radionuclide uptake across the sacrum and sacroiliac joints. Four cases of osteoporotic sacral fracture with confirmation by computed tomography are included in this report.

Thermographic validation of physical complaints in ‘psychogenic pain’ patients

To determine whether some patients complaining of chronic unexplained pain had received inappropriate psychiatric diagnoses, we used thermography to evaluate 224 consecutive patients. Abnormal results were found in 43 patients (19%), leading to diagnoses of reflex sympathetic dystrophy, nerve root irritation, and thoracic outlet syndrome. Three case histories illustrated by thermograms demonstrate the value of thermography in detecting otherwise overlooked organic disorders, particularly sympathetic dysfunction, that may easily be misdiagnosed as psychogenic pain.

Lumbar, cervical and thoracic thermography in the evaluation of nerve root irritation

Lumbar, cervical and thoracic thermography in the evaluation of nerve root irritation

Back Pain in an Adolescent-Reply

In Reply.— Disk protrusion does occur in 15-year-old boys, but rarely so. Low-back myofascial strain is by far the more common injury in a young man with strong muscles guarding a healthy spine. Straight leg-raising can rotate the pelvis and through ligamentous or muscle pull irritate the lumbosacral region, producing pain in this condition. 1 Radiation or referral of pain can occur without nerve root irritation, and, indeed, the experimental injection of hypertonic saline solution into the lumbosacral supraspinous ligament has generated sciatic-like pain reaching as far distal as the calf. 2 Restricted kick is nonspecific; although it might suggest quadriceps weakness, it could as well indicate guarding to avoid discomfort. In the face of usual and symmetrical deep-tendon reflexes, normal sensation, unilateral positive straight leg-raising (unconfirmed by forced ankle dorsiflexion) only at 70° and roentgenographic findings negative for disk space or foraminal narrowing or pathological condition, I believe the

Interruption of pain pathways in the treatment of the cervical syndrome.

In the cervical syndrome a distinction should be made between an upper and a lower type. The upper type is usually emanating from the intervertebral or facetal joints, since pathology causing nerve-root irritation is confined to the more caudal segments. In the lower type nerve-root irritation is usually the cause of pain but secondary irritation of the facetal joints can be an important contributing factor. Treatment should primarily be conservative. If this fails and if surgical intervention is not indicated an attempt should be made to interrupt pain pathways. This can be done by division of the posterior primary rami or by making a radio-frequency lesion in the dorsal root ganglion. The results indicate these procedures can be of considerable help in a group of patients who do not respond to any other treatment.

An Anterior Extraperitoneal Muscle-Splitting Approach for Pediatric Renal Surgery

We describe the successful use of an anterolateral, muscle-splitting technique. In the pediatric patient impressive exposure allows for renal pelvic and distal ureteral operations, obviating the necessity for a secondary lower incision. Additional benefits of this incision have been minimal nerve root irritation, incisional pain and muscular weakness.

EXAMINATION OF THE CERVICAL SPINE

Examination of the cervical spine is discussed briefly in relation to history, neurological examination, vertebrobasilar insufficiency and x-rays. The general principles of examining cervical movements are presented. Details of the examination are discussed in more detail under the following headings: the upper cervical spine and its examination for cervical headache; the middle cervical spine with its examination being related to spondylosis/arthrosis; the middle and lower cervical spine and its examination related to wry neck, nerve root irritation or compression, and whiplash injury.

Sciatica caused by an intrauterine device after silent uterine perforation. A case report.

A case is described in which sciatic nerve-root irritation was caused by an IUD that had penetrated the uterine wall and migrated to the vicinity of the 1st sacral nerve roots though remaining intrapelvic and intraperitoneal. The IUD was removed without difficulty and the pain symptoms disappeared completely. Clinical evidence of IUD perforation includes absence of the telltale of the device. Rarely a free IUD is palpable in the pouch of Douglas during bimanual examination. The case emphasizes the need for thorough roentgenographic evaluation of all patients with low-back pain and sciatica.

Back pain: osteoarthritis.

Back pain is one of the chief complaints of the elderly. It may be either a chronic deep skeletal muscular pain or an acute circumscribed pain arising from nerve-root irritation. The main causes of back pain in older people are: 1) degenerative changes (spondylosis, osteoarthritis, ankylosing hyperostosis); 2) malignancy (multiple myeloma, metastases from carcinoma or lymphoma); and 3) metabolic disorders (osteoporosis, osteomalacia, chondrocalcinosis, Paget's disease). Mechanisms and variations are discussed in detail.

Recurrent conjugal neuralgia caused by Herpesvirus hominis type 2

Leg neuralgia is usually caused by nerve root irritation, and is seldom considered of viral origin. Two married couples had recurrent leg pain in a dermatome distribution. In each episode, after one to three days of neuralgia, herpetic vesicles appear on or near the genitalia. Herpesvirus hominis (HVH) was isolated from vesicles or cervix in three patients and was serologically identified as herpesvirus hominis type 2. Prolonged follow-up has not shown progression of the syndrome or any permanent neurologic damage. Treatment with topical neutral red and photoinactivation has not only reduced local lesion healing time and frequency of attacks, but it has also given prompt relief of neuralgia. (<i>JAMA</i>236:587-588, 1976)

Recurrent Conjugal Neuralgia Caused by Herpesvirus Hominis Type 2

Leg neuralgia is usually caused by nerve root irritation, and is seldom considered of viral origin. Two married couples had recurrent leg pain in a dermatome distribution. In each episode, after one to three days of neuralgia, herpetic vesicles appear on or near the genitalia. Herpesvirus hominis (HVH) was isolated from vesicles or cervix in three patients and was serologically identified as herpesvirus honinis type 2. Prolonged follow-up has not shown progression of the syndrome or any permanent neurologic damage. Treatment with topical neutral red and photoinactivation has not only reduced local lesion healing time and frequency of attacks, but it has also given prompt relief of neuralgia.

Sources of Failure in Laminectomies

Failures in laminectomy may be due to improper patient selection, of which the largest factor appears to be a lack of recognition of an underlying psychological disorder. Rarely an operative procedure is performed on the wrong side or at the wrong level. A number of elements relating to what might be termed the "wrong operation" fall under the heading of failure to recognize disease, and the largest factor here in our experience has been the inability to explore the wound because of uncontrolled bleeding. The problem also relates to a lack of understanding of the anatomy and potential disorder of the vertebral axis. This then merges with the other factor, failure to deal with disease, which may be unrecognized or, if identified, misinterpreted. Last are those elements for which there is professional responsibility, the most serious being dural or nerve root irritation predisposing to traumatic arachnoiditis.

Tinel's Percussion Test For Intraspinal Sensory Nerve Root Involvement

To the Editor:— Although Tinel in 1915 introduced the percussion sign, known by his name, to evaluate interruption or regeneration of a peripheral nerve, a review of his original paper and recent texts on neurological diagnosis reveals no mention of this percussion test to diagnose or localize intraspinal sensory nerve root involvement.1-3 The purpose of this letter is to recommend the use of finger tapping or percussion along the course of a sensory dermatomere to elicit the sensation of tingling or pins and needles or paresthesias, as an additional or corroboratory sign, of irritation or involvement of a specific spinal sensory nerve root supplying the percussed dermatomere. For example, if the sixth cervical root in involved intraspinally by intrinsic nerve pathologic condition or by pressure from a disk, osteophyte, or tumor, the patient will often complain of pain referred to the sensory dermatomere supplied by this cervical root, namely

Back and Neck Pain and Associated Nerve Root Irritation in the New York City Fire Department

*Surgeon, Retired, The New York City Fire Department; Attending Orthopaedist, The Mount Siani Hospital; Professor of Clinical Orthopaedics, The Mount Sinai Hospital Medical School; Chief, Orthopaedic Department, The Mount Sinai Hospital Services, City Hospital Center at Elmhurst, N.Y.