Differential Diagnosis and Management of Spinal Nerve Root‐related Pain

Abstract

Pain originating from spinal nerve roots demonstrates multiple pathogeneses. Distinctions in the pathoanatomy, biomechanics, and pathophysiology of spinal nerve roots contribute to pathology, diagnosis, and management of root-related pain. Root-related pain can emerge from the tension events in the dura mater and nerve tissue associated with primary disc related disorders. Conversely, secondary disc-related degeneration can produce compression on the nerve roots. This compression can result in chemical and mechanical consequences imposed on the nervous tissue within the spinal canal, lateral recess, intervertebral foramina, and extraforminal regions. Differences in root-related pathology can be observed between lumbar, thoracic, and cervical spinal levels, meriting the implementation of different diagnostic tools and management strategies.

Oblique interlaminar lumbar epidural steroid injection for management of low back pain with lumbosacral radicular pain - A case report -

“…The mechanism of low back pain with radiculopathy was originally thought to be associated with direct pressure on nerve roots caused by herniated discs and/or spinal stenosis. However, currently inflammatory response and various inflammatory events, in addition to mechanical pressure, have been reported as the major causes of radiculopathy [6,7]. A previous study reported that phospholipase A2 activity at the site of lumbar herniated intervertebral discs increased 100,000-fold compared with that in other tissues [8].…”

Honey can prevent epidural fibrosis development after laminectomy: an experimental study

“…One of the most important causes of failed back surgery is the development of epidural fibrosis following laminectomy (3,9,18,19). EF consists of a mixture of cellular elements containing fibroblasts and inflammatory cells.…”

“…The nerve will be distracted or compression will occur because of the contraction of the adhesions of the scar formation surrounding the nerve. Such adhesions can disturb the axoplasmic transport within the nerve fibers, arterial circulation and venous drainage (3,9,18,19). Many studies have been performed and many substances have been used to prevent EF developing after spinal surgery including fatty grafts as a solid barrier, polyvinyl alcohol, hydrogel membrane, polytetrafluoroethylene membrane, polylactic acid membrane, vicryl mesh; sodium hyaluronate as a viscous Thin fibrous bands present between the scar tissue and dura mater 2…”

A less invasive surgical approach in the lumbar lateral recess stenosis: direct approach to the medial wall of the pedicle

“…For exit zone stenosis, Maher and Henderson advocate approaching the foramen from the interlaminar space below the level of the root; that is, between the L-5 and S-1 laminae for an L-5 [29]. Laminal fenestration techniques have also been described for exit zone stenosis [9,39].…”