spinal nerve compression
Introduction
Introduction The spinal nerves are mixed nerves whose sensory fibers begin in pseudomonopolar neurons of the spinal ganglia. The central processes of pseudomonopolar neurons are rooted into the spinal cord, and the peripheral nerves are added to the spinal nerves, distributed in the skin, muscles, joints, and visceral sensilla, etc., and the sensory impulses of the body and the internal organs are transmitted to the center. The motor fibers are composed of the anterior horn of the gray matter, the thoracolumbar lateral angle, and the axons of the parasympathetic nucleus motor neurons distributed in the striated muscle, smooth muscle, and gland. Compression of the spinal nerves can lead to numbness in the limbs and limited sensory and motor function.
Cause
Cause
First, the disc herniation can oppress the spinal nerve
The cause of intervertebral disc herniation has internal and external causes. The main cause is degenerative changes of the lumbar spine; external causes include trauma, strain or overwork, and cold and dampness.
1. Degenerative changes in the intervertebral disc
The intervertebral disc lacks blood supply, and the repair energy is weak. In daily life, the intervertebral disc is squeezed, pulled and twisted in various aspects, and the nucleus pulposus, the annulus fibrosus, and the cartilage plate are gradually aging, which causes the annulus fibrosus to be easily broken, and the intervertebral disc is caused. protruding.
2, long-term vibration
When the driver of the car and the tractor is in the sitting position and bumping state for a long time, the pressure on the lumbar intervertebral disc is too large, which may cause the disc to degenerate and protrude. At the same time, the vibration also affects the nutrition of the intervertebral disc, and the influence on the microvessels can accelerate the disc herniation.
3, excessive load
When the waist is overloaded, long-term work is done, such as: coal miners or construction workers, who need to bend over to take heavy objects for a long time. When the weight of the lumbar intervertebral disc exceeds 100 kPa/cm 2 , the intervertebral disc annulus is broken.
4, trauma
Because the lumbar vertebrae are physiologically lordotic, the intervertebral disc is thick and thin before the anterior disc. When the patient is injured in the waist, falls, flashed, etc., the nucleus pulposus of the intervertebral disc moves backward, and the intervertebral disc protrudes backward.
5, waist wear
As early as 1935, it was reported that the lumbar intervertebral space narrowed and the intervertebral disc was prominent.
6, other
(1) Age: The incidence of disc herniation is 64.46% for 20-40 years old, 34.92% for those over 40 years old, and the average age is 40.8 years old.
(1) Height: Men and women who exceed the normal average height.
(2) Genetics: This is also the consideration of etiology.
(3) Pregnancy: The entire ligament system is in a relaxed state during pregnancy. The posterior longitudinal ligament is prone to intervertebral disc bulging on the basis of relaxation and degeneration, and the incidence of multiple pregnancies is increased.
(4) Smoking: There have been many reports of changes in blood flow in smoking.
(5) Diabetes: often caused by increased arteriosclerosis, easily lead to blood circulation disorders.
Second, tumor compression spinal nerve
Examine
an examination
Related inspection
Molybdenum target X-ray examination chest test
When the spinal cord is compressed, dyskinesia occurs before the sensory disturbance. In addition to the compression of the spinal cord tissue, it may be accompanied by blood circulation disorders, cerebrospinal fluid dynamics, and complications such as inflammation and adhesion.
1. Perform neurological-related sensory and motor function tests, such as touching the patient's skin with something cold, observing the patient's reaction, and asking the patient for the feeling; performing knee reflexes.
2, X-ray or other examinations are not difficult to find a compression of the spinal nerves by the disc or other foreign bodies, resulting in a skew of the spinal nerves.
Diagnosis
Differential diagnosis
Lumbar disc herniation:
First, low back pain and radiation pain on one side of the lower extremity are the main symptoms of the disease. Low back pain often occurs before leg pain, or both can occur at the same time. Most of the history of trauma can also have no clear cause. The pain has the following characteristics:
1. Radiation pain along the sciatic nerve conduction, directly to the lateral side of the calf or toe, such as the waist 3-4 gap protruding due to the compression of the lumbar 4 nerve roots to the front of the thigh radiating pain.
2. All the actions that increase the pressure of the cerebrospinal fluid such as coughing and sneezing and defecation can aggravate low back pain and radiation pain.
3. Pain during activity is exacerbated after rest. The majority of patients use the lateral position and flexion of the affected limb. Individual severe cases are painful in various positions. They can only bend their hips and knees in bed to relieve symptoms and lumbar spinal stenosis. There are intermittent limps.
Second, scoliosis deformity: the main bend in the lower back flexion is more obvious lateral bending depends on the relationship between the protruding nucleus and the nerve root: if the anterior trunk located in the nerve root is generally bent to the affected side, left: nucleus The pain is exacerbated by the curvature of the anterior spine in the nerve root to the affected side, such as the curve to the healthy side. Right: the nucleus pulposus is located outside the nerve root. The spine of the anterior spine is curved to the healthy side.
Third, the spinal activity is restricted: the nucleus pulposus protrudes against the nerve root, so that the protective tension of the lumbar muscle can occur on one side or both sides. Because of the lumbar muscle tension, the lumbar lordosis of the lumbar spine disappears and the anterior flexion and extension of the spine are restricted before the activity is restricted. When flexion or extension, there may be a limitation of radiation pain to one side of the lower extremity, and often only one side can be differentiated from lumbar tuberculosis or tumor.
4. Lumbar tenderness with radiation pain: There is a limited tenderness point next to the spinous process on the affected side of the intervertebral disc and accompanied by radiation pain to the calf or foot. This point is important for diagnosis.
5. Straight leg raising test is positive: due to differences in personal physique, the test is positive. There is no uniform degree standard. It should be noted that both sides of the affected side have limited leg lift and feel the radiation pain to the calf or foot is positive and sometimes raises the healthy limb. The occurrence of numbness in the affected leg is caused by the traction of the affected nerve. This point is of great value to the diagnosis.
