Root compression syndrome

from Wikipedia, the free encyclopedia
Classification according to ICD-10
G55 * Compression of nerve roots and nerve plexuses in diseases classified elsewhere
ICD-10 online (WHO version 2019)

In medicine, the root compression syndrome describes the mechanical irritation of a nerve root in the area of ​​the spine . The main symptom is the characteristic back pain (e.g. lumbar sciatica ) radiating into the dermatome of the affected nerve root, a positive Lasègue sign with lumbar root compression, possibly flaccid paresis and weakened muscle reflexes .

Etiology of root compression syndrome

It is usually caused by sudden changes in the spine configuration, e.g. B. in the case of a herniated disc ( disc prolapse) or a more pronounced protrusion of the disc ( disc protrusion). The majority of intervertebral disc (actually nucleus pulposus ) incidents occur at the level of the lumbar spine (lumbar), which is particularly exposed to mechanical stress . Lateral incidents press the nerve root exiting on the same floor. The more common half-lateral (mediolateral) incidents tend to affect the next lower nerve root. Larger herniated discs or sequesters can also press on several roots at the same time. The rare central (medial) prolapse can lead to the cauda equina syndrome in the lumbar region , which is also a root compression syndrome; in higher segments, however, to myelopathy .

In older people, the root compression syndrome can be caused by increased bone formation ( osteo- or spondylophytic attachment reactions) in the context of increased degenerative changes, but also by excessive soft tissue reactions (ligamenta flava hypertrophy). These processes are chronic in nature and occur predominantly in the cervical and lumbar spine area.

The nerve roots are located in or directly adjacent to the nerve outlet openings of the spinal nerves ( intervertebral holes , foramina intervertebralia ), so that there is a forceps mechanism made of already existing (bony) and now added material and the irritation occurs due to increased pressure. The irritation also leads to a swelling of the nerve root ( edema formation), which further exacerbates the situation in tightly preformed anatomical conditions.

More rarely, compression of nerve roots can occur in vertebral fractures , tumors or hematomas .

therapy

In the case of incidents of the nucleus pulposus one waits first for the mostly favorable spontaneous course; Painkillers are prescribed and physiotherapeutic measures are initiated as soon as possible . The effect of massages or mud packs is very limited. Only persistent, therapy-resistant pain or manifest neurological deficits are still an indication for neurosurgical intervention today . The herniated material is removed, usually also part of the vertebral arch ( laminectomy ).

See also

literature