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3 results

  • Chapter 12 - Spinal Nerve Roots

  • Robert Laureno, Georgetown University, Washington DC
  • Book:
    Insights into Clinical Neurology
    Published online:
    27 July 2023
    Print publication:
    20 July 2023, pp 63-65

  • Summary

    Principles of anatomy relevant to radiculopathy are discussed. Spondylotic pathology is proximal to the dorsal root ganglia (DRG). As a result DRG axons to the periphery are unaffected. This topography means that sensory radicular symptoms are unaccompanied by abnormality on sensory nerve conduction studies. Due to regional differences in the angulation of the intervertebral foramina, sagittal MRI images are better for demonstrating foraminal stenosis in the lumbar than in the cervical region. Myotomes and dermatomes vary between individuals.

  • Chapter 20 - Opioids

  • from Section 6 - The Management of Neuropathic Pain
  • Edited by Cory Toth, Dwight E. Moulin
  • Book:
    Neuropathic Pain
    Published online:
    05 December 2013
    Print publication:
    07 November 2013, pp 240-248

  • Summary

    Nerve root compression can occur from osteophyte formation, disc herniation, or a combination. As only 1-2% of patients with back pain have a nerve root or spinal cord compression, an accurate diagnosis of the causes of painful radiculopathy relies on a thorough history and physical exam. It is important to note that many asymptomatic individuals have abnormalities such as disc herniations and foraminal stenosis on CT and MRI. Therefore, the imaging findings must be correlated with the history and examination findings. Surgery for spinal stenosis and neurogenic claudication is indicated if severe pain is present, and can provide sustained relief. Since the spinal cord terminates at the L1-2 vertebral level, lumbar pathology below this level may compress the distal nerve root, causing a cauda equina syndrome. A lesion affecting the lumbosacral plexus (LSP) can present with pain in the low back, hip or pelvis, or with sciatica pain.

  • Perineural injection to nerve root and radicular blood flow: a clinical study during spinal surgery

  • M. Fukusaki, M. Miyako, T. Nakamura, H. Miyoshi, K. Sumikawa, H. Konishi, S. Hara
  • Journal:
    European Journal of Anaesthesiology / Volume 18 / Issue 2 / February 2001
    Published online by Cambridge University Press:
    16 August 2006, pp. 70-74
    Print publication:
    February 2001

  • Background and objective To investigate the effects of the perineural injection of lidocaine or corticosteroids on radicular blood flow during spinal surgery.

    Methods After lumbar discectomy, a probe for laser Doppler flowmetry was placed directly on the 4th or 5th lumbar nerve root. Thirty patients undergoing lumbar discectomy were randomly assigned to one of three groups. Each group received one of three protocols for a perineural injection to the nerve root: 1.0 mL 0.9% saline in group A, 1.0 mL 1% lidocaine in group B or 1.0 mL dexamethasone (4 mg) in group C. Measurements included radicular blood flow, mean arterial pressure, haemoglobin concentration, percutaneous oxygen saturation and end-tidal carbon dioxide tension. Radicular blood flow was measured by laser Doppler flowmetry before the injection and 15 min after these injections. The three groups were similar with respect to mean arterial pressure, haemoglobin concentration, percutaneous oxygen saturation and end-tidal carbon dioxide tension.

    Results Radicular blood flow did not change after the injection in any of the groups.

    Conclusions The results suggest that the perineural injection of 1% lidocaine or dexamethasone does not affect radicular blood flow during lumbar discectomy.