One of the main structural elements of the spine includes the spinal bones - also known as the vertebrae. This main part of the spine houses the spinal cord itself, as well as makes up the back wall of the thoracic cavity and serves as a posterior attachment for the ribs. The bones of the vertebral spine link together as the superior processes from the vertebra below connect to the inferior processes of the vertebra above it. Between the vertebral bodies and the facet joints, where the articular processes joint together, there is a space for the spinal nerves to exit the spinal cord and pass to the body. The spinal nerves are known as the nerve roots at this opening of the spine.
The opening of the spine where the spinal nerves exit is known as the intervertebral foramina. Normally, this opening in the spine is large enough for the spinal nerves to exit towards the body unobstructed. Due to certain spine conditions, such as herniated discs, degenerative disc disease, bone spurs, and osteoporosis, these openings may become tight. As the spinal nerves become squeezed by herniated disc material, the swelling of inflammation, or a host of other factors, the spinal nerves may become negatively affected. The squeezing of the nerves due to the narrowing of these openings, or as a result of them being pressed upon by adjacent structures, is known as nerve root compression.
As a result of nerve root compression, pain may be experienced at the location where the nerve has become affected. The pain may be isolated to the location of the compression, or it may radiate outward from the source of the injury.
The arms and legs are very long structures in the body, and they are supplied with major nerve branches that run across their entire length. For the nerves that supply an arm leg, the entire structure may be affected by the compression of the nerve near the nerve root. Radicular pain describes pain that travels the length of an upper or lower extremity as a result of the compression of a spinal nerve root.
The cause of radicular pain may be associated with back conditions such as peridural fibrosis, foraminal stenosis, muscle spasms, and herniated discs.
Sciatica is the most common symptom of radicular pain, associated with the compression of the sciatic nerve. This nerve runs the length of the leg, all the way into the ankles and feet.
Pathology: The Nerve roots are the sections of the spinal nerves where they exit the spine through the intervertebral foramina. The nerve roots are also known as the radicular nerves. Each nerve supplies an organ or skeletal muscle system with neurologic information to maintain organ function and the senses we feel as we consciously operate our own bodies.
When something presses into these nerves, the neurologic functioning may be affected. When one or more of the nerves of the lumbosacral spine become compressed, we may experience lower back pain and/or leg pain. Prolonged nerve irritation or compression could result in the loss of motor function of that leg (paralysis or paraplegia).
Treatments: Conservative treatments for radicular pain include medications, physical therapy, and icing. Epidural injections may be the next step in treating this condition more invasively is the conservative treatments don't have their intended effect. Technically, epidural steroid injections are considered a minor surgery, and patients who receive it are expected to be provided with a drive home from the hospital or clinic. That being said, complications from epidural steroid injections are very rare, and patients walk away from the treatment after a brief recovery period.v
If none of these treatment options provide patients with enough relief, decompressive surgery may help patients to regain a more pain free and productive life. The two most common back surgery options used to treat radicular pain include the discectomy and laminectomy.