Jean-Marie Berthelot1, Jean-Denis Laredo2, Christelle Darrieutort-Laffite3, Yves Maugars3. 1. Rheumatology Unit, Nantes University Hospital, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 01, France. Electronic address: jeanmarie.berthelot@chu-nantes.fr. 2. Service de radiologie ostéo-articulaire, hôpital Lariboisière-Fernand-Widal, université Paris-Diderot-Sorbonne, Paris-cité, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France. 3. Rheumatology Unit, Nantes University Hospital, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 01, France.
Abstract
PURPOSE: To perform a synthesis of articles addressing the role of stretching on roots in the pathophysiology of radiculopathy. METHODS: Review of relevant articles on this topic available in the PubMed database. RESULTS: An intraoperative microscopy study of patients with sciatica showed that in all patients the hernia was adherent to the dura mater of nerve roots. During the SLR (Lasègue's) test, the limitation of nerve root movement occurs by periradicular adhesive tissue, and temporary ischemic changes in the nerve root induced by the root stretching cause transient conduction disturbances. Spinal roots are more frail than peripheral nerves, and other mechanical stresses than root compression can also induce radiculopathy, especially if they also impair intraradicular blood flow, or the function of the arachnoid villi intimately related to radicular veins. For instance arachnoiditis, the lack of peridural fat around the thecal sac, and epidural fibrosis following surgery, can all promote sciatica, especially in patients whose sciatic trunks also stick to piriformis or internus obturator muscles. Indeed, stretching of roots is greatly increased by adherence at two levels. CONCLUSIONS: As excessive traction of nerve roots is not shown by imaging, many physicians have unlearned to think in terms of microscopic and physiologic changes, although nerve root compression in the lumbar MRI is lacking in more than 10% of patients with sciatica. It should be reminded that, while compression of a spinal nerve root implies stretching of this root, the reverse is not true: stretching of some roots can occur without any visible compression.
PURPOSE: To perform a synthesis of articles addressing the role of stretching on roots in the pathophysiology of radiculopathy. METHODS: Review of relevant articles on this topic available in the PubMed database. RESULTS: An intraoperative microscopy study of patients with sciatica showed that in all patients the hernia was adherent to the dura mater of nerve roots. During the SLR (Lasègue's) test, the limitation of nerve root movement occurs by periradicular adhesive tissue, and temporary ischemic changes in the nerve root induced by the root stretching cause transient conduction disturbances. Spinal roots are more frail than peripheral nerves, and other mechanical stresses than root compression can also induce radiculopathy, especially if they also impair intraradicular blood flow, or the function of the arachnoid villi intimately related to radicular veins. For instance arachnoiditis, the lack of peridural fat around the thecal sac, and epidural fibrosis following surgery, can all promote sciatica, especially in patients whose sciatic trunks also stick to piriformis or internus obturator muscles. Indeed, stretching of roots is greatly increased by adherence at two levels. CONCLUSIONS: As excessive traction of nerve roots is not shown by imaging, many physicians have unlearned to think in terms of microscopic and physiologic changes, although nerve root compression in the lumbar MRI is lacking in more than 10% of patients with sciatica. It should be reminded that, while compression of a spinal nerve root implies stretching of this root, the reverse is not true: stretching of some roots can occur without any visible compression.
Authors: Hee Joon Jeong; Woo Seog Sim; Hue Jung Park; Seung Hwan Lee; Min Seok Oh; Min Kyoung Cho; Heui Jin Seon; Jin Young Lee Journal: Medicine (Baltimore) Date: 2019-08 Impact factor: 1.817