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With or without nerve root involvement · Forms · Back pain E 04 What does “back pain with or without nerve root involvement” mean?▯ A backache or back pain is not a disease per se, but should be understood▯ as a warning signal issued by the body. A number of different causes can account for “back pain” as a symptom, causes tha▯t, without treatment, may either disappear all by themselves or have very serious consequences for the patient. The task of the treating physician is to collect the symptoms reported by the patient, i▯nterpret them, and arrive at a diagnosis. A careful interview of the patient, plus physical and neurological examina▯tions, can provide valuable information as to whether it is a case of “simple” or “complex” back pai▯n. This initial difference is decisive, for the physician must decide whether additional instrument examinations are required for a differential diagnosis (conventional x-rays, computer tomography, nuclear magnetic resonance imaging and other methods), whether conser▯vative treatment can commence, and even whether a surgical option should be con▯sidered. Simple back pain without spinal nerve root involvement can be caused by ▯a number of individual factors (excessive loads, muscular imbalances within the muscles of the back, t▯rigger points, etc.) and can as a rule be · Prof. Dr. Jürgen Harms · www.harms-spinesurgery.com treated effectively and long-lastingly using physical treatment methods, physiothe▯rapy, regular exercise, muscle strengthening exercises and, if necessary, the use of mild anti-inflammatory and painkilling drugs. Back pain with spinal nerve root involvement is also called radicular pa▯in. This means that the pain is caused by pressure on the spinal nerves, resulting in pain and motor or sensory deficits in the areas supplied by the specific spinal nerves. A total of 31 pairs of spinal nerves emerge from the spinal cord along its entire length, corresponding to the 31 spinal segments. Every spinal segment has a precisely defined area of the body Spine Surgery Information Portal allocated to it for which it transfers neurological information. The dorsal nerve roots (radix dorsalis) and ventral nerve roots (radi▯x ventralis) combine to form a spinal nerve, which emerges through the intervertebral foramen. The dorsal root of the spinal nerve is a sensitive sensory nerve root th▯at receives sensory signals from the body and carries them to the brain. The ventral nerve root carries impulses („commands”) to organs o▯r tissues (e.g. muscles), that instruct them to carry out some action. The term afferent is used to refer to the “sensory” neural function and the t▯erm efferent is used for the “executory” function. The allocation of the spinal cord segments always refers to the area whe▯re the spinal nerves emerge from the spinal cord through the intervertebral foramen be▯tween two adjacent vertebra on the way to their respective areas. Prof. Dr. med. Jürgen Harms · Klinikum Karlsbad-Langensteinbach · Guttm▯annstraße 1 · 76307 Karlsbad 1 ©www.harms-spinesurgery.com 2007. All rights reserved. With or without nerve root involvement · Forms · Back pain E 04 The tables below contain examples of spinal segments in the cervical and▯ lumbar spine along with their characteristic muscles and the areas in which pain or dysesthesias (dis▯turbances of sensory function) can be expected in response to pressure applied to the corresponding spinal ner▯ve root: • Spinal nerve segments of the cervical spine Segment Areas of pain or Characteristic muscle Reflex weakened dysesthesia Shoulder and side of the C5 m.deltoideus upper arm Radial upper andlower arm, C6 thumb m.biceps, m.brachioradialis Radius periosteum · Prof. Dr. Jürgen Harms · www.harms-spinesurgery.com C7 Back of lower arm, middle and Ball of the thumb, Triceps index fingers m.pronator teres C8 Back of lower arm, pinky and Ball of the pinky, ring finger mm.interossei, digital flexor • Spinal nerve segments of the lumbar spine Spine Surgery Information Portal Characteristic Lumbar Region in which pain and muscle spine dysesthesias are felt with motor Reflex weakened Nerve extension pain segment dysfunction Extension pain in nervus L1/L2 groin Iliopsoas femoralis L3 Outer and front side of thigh Iliopsoas, Patellar (knee jerk) reflexxtension pain in nervus quadriceps femoralis Extension pain in nervus L4 Outer and front side of thigh,Quadriceps Patellar (knee jerk) reflexemoralis, inner side of calf and foot positive Lasègue Outer side of lower leg, Extensor hallucis L5 inner side of top of the foot,longus positive Lasègue big toe Back of the calf, heel, outer S1 edges of toes 3-5 Triceps surae Achilles (ankle jerk) reflpositive Lasègue Radicular pains with pronounced abnormalities in the corresponding areas supplied by the specific spinal nerves affected may result from pressure on the spinal nerve roots from the follo▯wing conditions: · Herniated intervertebral discs · Spinal canal stenosis (narrowing of the spinal canal) · Tumor growth · Inflammatory diseases of the spinal column In the presence of clear radicular symptoms, a diagnosis is reached by m▯eans of additional instrumental examinations. Therapy is then individually designed based on the clinical and instrumental findings as well as the symptoms. Prof. Dr. med. Jürgen Harms · Klinikum Karlsbad-Langensteinbach · Guttm▯annstraße 1 · 76307 Karlsbad ©www.harms-spinesurgery.com 2007. All rights reserved. 2
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