It is the loss or decrease of the sensory or motor function of a nerve root, causing symptoms such as pain, tingling and weakness, radiating down the leg.
It is due to the degeneration of the discs located between vertebrae, whose function is to cushion the shock of the vertebrae in movement. By losing part of their water content, the discs lose their flexibility and become more prone to tearing or rupture. Another contributing factor is a sedentary lifestyle, as the muscles that give stability to the spinal column are not exercised.
Diagnosis is based on a correct clinical history and physical examination, requiring complementary tests such as X-ray, CT or MRI to detect alterations in the spine, identifying the affected nerve and its cause. An EMG may also be requested to assess the presence of lesions that may affect the nerves and muscles.
For the treatment of acute pain, Paracetamol, NSAIDs and even opiates are used. Cortisone may be used in some cases, either orally or through injections near where the nerve is pinched. In cases where the pain becomes chronic, tricyclic antidepressants such as amitriptyline, anticonvulsants such as gabapentin and pregabalin, and physical therapy treatment may be associated. In the most severe cases, the physician may indicate surgery, mainly to decompress the affected nerve root.
At the level of the last lumbar vertebra and the sacrum, multiple nerve roots emerge from the spinal column, forming what is known as the cauda equina. These are the ones that control the lower limbs and the pelvic organs.
When they are affected, there is lumbar pain, in the perineal region or in the lower limbs, associated with a loss of sensation in the genitals and anus, in the skin of the perineum and thighs, as well as impotence, constipation, incontinence or the inability to urinate.
It is a medical emergency, which must be intervened immediately, as some symptoms may become irreversible and the patient's condition may worsen in as little as 24 hours. It requires emergency surgical decompression to reduce or eliminate pressure on the nerve.
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