Pathoanatomy and Pathophysiology of Nerve Root Compression

Rydevik, Björn; Brown,; Lundborg, Göran

doi:10.1097/00007632-198401000-00004

Cited by 449 publications

(186 citation statements)

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“…Pain occurs if an inflamed nerve is compressed [24]. Pain associated with root compression in patients with disk herniation or spinal degeneration is considered to be caused by a combination of mechanical, biochemical and metabolic irritation, leading to electrophysiologic and microcirculation changes with ischaemia, intraneural oedema and demyelination [51,52]. Patients with long-standing root compression may not consider radicular pain as a significant symptom and the patients may instead complain of muscle weakness and sensory loss, depending on the duration of root compression [27].…”

Section: Discussionmentioning

confidence: 99%

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Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study

et al. 1997

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This prospective, randomised study compares the efficacy of surgery, physiotherapy and cervical collar with respect to pain, motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment, with or without an additional bulging disk, as verified by MRI or CT-myelography. Pain intensity was registered on a visual analogue scale (VAS), muscle strength was measured by a hand-held dynamometer, Vigorometer and pinchometer. Sensory loss and paraesthesia were recorded. The measurements were performed before treatment (control 1), 4 months after the start of treatment (control 2) and after a further 12 months (control 3). A healthy control group was used for comparison and to test the reliability of the muscle-strength measurements. The study found that before start of treatment the groups were uniform with respect to pain, motor weakness and sensory loss. At control 2 the surgery group reported less pain, less sensory loss and had better muscle strength, measured as the ratio of the affected side to the non-affected side, compared to the two conservative treatment groups. After a further year (control 3), there were no differences in pain intensity, sensory loss or paraesthesia between the groups. An improvement in muscle strengths, measured as the ratio of the affected to the non-affected side, was seen in the surgery group compared to the physiotherapy group in wrist extension, elbow extension, shoulder abduction and internal rotation, but there were no differences in the ratios between the collar group and the other treatment groups. With respect to absolute muscle strength of the affected sides, there were no differences at control 1. At control 2, the surgery group performed somewhat better than the two other groups but at control 3 there were no differences between the groups. We conclude that pain intensity, muscle weakness and sensory loss can be expected to improve within a few months after surgery, while slow improvement with conservative treatments and recurrent symptoms in the surgery group make the 1-year results about equal.

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Section: Discussionmentioning

confidence: 99%

“…Paraesthesia was the symptom that did not differ between the groups at control 2. Paresthesia and numbness are symptoms that can occur as a consequence of pure mechanical root compression without inflammatory irritation at the spinal root [51,52].…”

Section: Discussionmentioning

confidence: 99%

Cervical radiculopathy: Pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar A prospective, controlled study

et al. 1997

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“…Such mechanical compressions of the nerve root may induce functional changes, such as sensory de®cit, motor weakness, and pain. 1,3 Rydevik reported that compression of the nerve root caused structural damage to the nerve ®bers, and impairment of intraneural blood¯ow; i.e. ischemia, and formation of intraneural edema.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Radiographic examinations, such as magnetic resonance imaging (MRI), myelography, and computed tomographic (CT) myelography, usually reveal ®ndings of compression in patients with disc herniations and/or spinal stenosis. However, we sometimes encounter patients with sciatic pain whose radiographic examinations reveal neither lumbar disc herniations nor spinal stenosis.…”

Section: Introductionmentioning

confidence: 99%

Fibrous adhesive entrapment of lumbosacral nerve roots as a cause of sciatica

Ido

Urushidani

2001

Spinal Cord

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Study design: Report of seven patients with ®brous adhesive entrapment of lumbosacral nerve roots as a cause of sciatica, whose radiographic ®ndings were negative and who experienced relief from sciatica immediately after the entrapment was released. Objectives: To describe a new clinical entity of ®brous adhesive entrapment of lumbosacral nerve roots with negative radiographic ®ndings. Setting: Orthopaedic department, Japan. Methods: Clinical evaluation and post-operative outcome in seven patients with entrapment of lumbosacral nerve roots because of ®brous adhesion con®rmed intraoperatively. Results: Radiographic examinations by magnetic resonance imaging (MRI), myelography, and computed tomographic (CT) myelography demonstrated neither disc herniations nor spinal stenosis in all seven patients, and di erential nerve root block was e ective for relieving sciatica and low back pain. We con®rmed, intraoperatively, entrapment of the nerve root by ®brous adhesion, and all seven patients were relieved from sciatica and low back pain postoperatively. Conclusion: This study presented seven patients with sciatica caused by ®brous adhesive entrapment of lumbosacral nerve roots who underwent decompression and release of ®brous adhesion. Radiographic examinations, such as MRI, myelography and CT myelography, showed no compressive shadows and also di erential nerve root block was e ective for its diagnosis. This study seems to be the ®rst report of patients with entrapment of lumbosacral nerve roots caused by ®brous adhesion, whose radiographic ®ndings were negative. Spinal Cord (2001) 39, 269 ± 273

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“…Of particular interest was the iliolumbar ligament, as well as the ligamentous tissue connections between the fifth lumbar vertebral body and the sacrum, which are to be interpreted partly as belonging to the iliolumbar ligament and partly as independent structures [2,19,27]. Rydevik and co-workers [38] distinguished mechanical deformation, impairment of the microcirculation and the formation of an intraneural edema as pathophysiologic causes of peripheral nerve lesions. The latter part of the present study focused on determining whether and to what extent, on non-fixed cadavers, the pressure and traction forces exerted on the L5 nerve root during the distraction and translation process are liable to cause such lesions.…”

Section: Objective and Clinical Relevancementioning

confidence: 99%